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Article
November 1940

BLEEDING ESOPHAGEAL VARICESAN EVALUATION OF METHODS DIRECTED TOWARD THEIR CONTROL, ESPECIALLY BY DIRECT INJECTION OF A SCLEROSING SOLUTION

Author Affiliations

Fellow in Surgery, the Mayo Foundation ROCHESTER, MINN.
From the Division of Surgery (Dr. Walters) and the Division of Medicine (Dr. Moersch), the Mayo Clinic.

Arch Surg. 1940;41(5):1101-1117. doi:10.1001/archsurg.1940.01210050061004
Abstract

Esophageal varices develop as a result of obstruction of the portal or splenic veins because the esophageal veins are one of the three sites of communication between the portal and caval systems. Since the veins in the submucosa of the lower part of the esophagus are poorly supported by loose connective tissue, with the increase in the quantity of blood passing through them varices develop, become superficial to esophageal mucosa and are prone to rupture.

The frequency with which bleeding occurs from esophageal varices was emphasized by Preble's1 review of 60 cases of fatal gastrointestinal bleeding in 80 per cent of which esophageal varices were found. In 50 per cent of the cases in which varices were present, macroscopic demonstration of the site of perforation of the varix was possible. Rivers and Wilbur2 found that in 5 per cent of a group of 668 patients with a history

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