THERE is a group of children and young adults who bleed frequently and severely from esophageal varices. These patients have normal livers and the varices are the result of a congenital block of the portal or splenic veins. If the bleeding could be controlled, these patients would return to perfect health and would have a normal life expectancy.
Splenomegaly secondary to venous stasis is a constant finding in these cases, but it is rare that splenectomy permanently controls the tendency to bleed. Unfortunately, the majority of the patients have had their spleens removed, and after removal of the spleen it is not possible to use the splenic vein to effect a shunt between the portal and systemic veins.
The young patient whose spleen has been removed cannot be helped by anastomosis of the portal vein to the vena cava. The block, in these cases, is either in the splenic vein proximal to the point of entry
CRILE G. TRANSESOPHAGEAL LIGATION OF BLEEDING ESOPHAGEAL VARICESA Preliminary Report of Seven Cases. Arch Surg. 1950;61(4):654-660. doi:10.1001/archsurg.1950.01250020660005