When massive upper gastrointestinal bleeding occurs, esophageal varices must be considered as a possible cause. The Sengstaken tube, equipped with a balloon that can be inflated after it has reached the stomach, also permits aspiration of gastric contents. If used as here suggested it will generally stop hemorrhage due to esophageal varices or give diagnostic clues when the hemorrhage is from other sources. While it is in place the patient requires constant nursing care, and such tamponage if continued longer than 48 hours increases the risk of subsequent operation. The timing of the definitive surgery, location of the incision, and type of operation are decided by the patient's history, general condition, and loboratory tests. For patients who have bled repeatedly from proved esophageal varices, who are not jaundiced, and who show no signs of ammonia intoxication, the recommended operation is portacaval end-to-side anastomosis.
Mackby MJ. TREATMENT OF BLEEDING ESOPHAGEAL VARICES. JAMA. 1959;171(14):1916–1922. doi:https://doi.org/10.1001/jama.1959.03010320006002
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