Emergency and Definitive Treatment of Bleeding Esophageal Varices

• Bleeding esophageal varices were the cause of 93 hospital admissions during a five-year period. The vascular impediment was extrahepatic in 28, and in this group there were no deaths; there were severe hemorrhages, but in most instances a satisfactory portacaval shunt was established. The impediment was intrahepatic in 65 patients, and 32 of these died; portacaval shunts were possible only in 33. When the diagnosis of bleeding from esophageal varices is clear, tamponade by intragastric balloon has been effective; emergency suture of the varices has then been done in 20 cases through a transpleural transesophageal incision. Thereafter it has been possible to prepare the patients for some type of shunt operation. Various portacaval shunts have been established or attempted in 131 patients in 10 years, with extremely encouraging results. Splenorenal anastomosis, done in 83 cases, is feasible if the spleen has been enlarged but impossible if there has been a splenectomy. Direct portacaval anastomoses were made in 36 cases. Eleven patients with extrahepatic portal bed block and 52 with cirrhosis of the liver have resumed full-time work after the establishment of splenorenal or direct portacaval shunts.