CURRENT PROBLEMS IN MANAGEMENT OF PATIENTS WITH PORTAL HYPERTENSION

• Bleeding from varices in patients with portal hypertension presents certain perplexing problems. The danger of recurrence of bleeding must be weighed against the hazards of the various types of shunting operations and the neuronutritional deficits that follow. In the individual case, portal venography and the determination of blood pressures in the portal system give valuable data. Three cases illustrate these points. In one patient an end-to-side portacaval anastomosis reduced the portal pressure from 35 cm. to 20 cm. of saline solution; bleeding did not recur. In the second patient varices persisted and hemorrhages recurred for years after splenectomy without evidence of portal hypertension; the varices disappeared and bleeding stopped after a limited esophagogastrectomy. A third patient illustrates the effectiveness of a portacaval shunt in reducing the portal blood pressure and abolishing an ascites that had not yielded to other measures. More information is needed as to the operative and postoperative hazards of shunting operations as compared with the danger of recurrent hemorrhages under improved medical treatment.