To the Editor.–I wish to comment on the report by Ackerman et al (Archives 1981;115:1454-1455). In the experience of my group,1 splenoportography was more useful than selective arteriography in preoperative evaluation of the patient with colostomal hemorrhage resulting from portal hypertension, and we recommend that splenoportography be used to demonstrate the anatomy of the portal system and portasystemic collaterals, rather than relying on arteriography, as Ackerman et al did. We did not find that local measures provided satisfactory palliation of colostomal hemorrhage resulting from portal hypertension, as Ackerman et al recommended, and we reported the successful control of such hemorrhage by mesocaval shunt. Therefore, we encourage the use of a shunting procedure in the management of this problem whenever feasible.
CRYSTAL RF. Portal Hypertension and Enterostomal Varices. Arch Surg. 1981;116(7):970. doi:10.1001/archsurg.1981.01380190094023