Subtotal Esophagectomy for Bleeding Esophageal Varices

ALTHOUGH definite progress has been made in the management of patients with portal hypertension, control of hemorrhage from esophageal varices in such cases remains a challenge to the medical profession. Varices appear in the mucosa of the lower esophagus as evidence of portal hypertension in a significant percentage of such cases, whether the portal obstruction is intrahepatic or extra-hepatic. Hemorrhage from the esophageal venous plexus may assume massive proportions, leading to fatal exsanguination, or result in repeated episodes of less severe bleeding, leading to chronic invalidism and secondary anemia. Esophageal varices are most frequently associated with portal cirrhosis. Eppinger 15 estimated that about 20% of patients with cirrhosis of the liver die of hemorrhage before ascites or hepatic insufficiency supervenes. Douglass and Snell 12 reviewed 444 cases of portal cirrhosis at the Mayo Clinic for the five-year period ending December, 1944, and reported that of the 85 patients who died,