PARTIAL ESOPHAGOGASTRECTOMY IN THE TREATMENT OF ESOPHAGOGASTRIC VARICES

Abstract

THE INEVITABLE life-taking character of hemorrhage from esophagogastric varices still stands as a challenge. Some success and much failure have attended the numerous attempts that have been made in its management.¹ Present evidence suggests that some forms of portacaval shunt offers substantial palliation to patients with generalized portal hypertension.² Undoubtedly the rare patients with distal splenic vein obstruction respond well to simple splenectomy. Most difficult to manage are young persons without evidence of cirrhosis or of generalized portal hypertension who present varices and splenomegaly, many having undergone ineffectual splenectomy. Basic understanding concerning the latter patients has changed little since Professor Banti's original observations made nearly three quarters of a century ago.³ Why should they early present morphologic evidence suggesting obstruction of only the splenic segment of the portal bed and yet later have definite cirrhosis manifest even by ascites? What effect might be obtained with early radical