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March 18, 1974

Portal Hypertension Five Years After Splenectomy

Author Affiliations

University of Arizona College of Medicine Tucson

JAMA. 1974;227(11):1260. doi:10.1001/jama.1974.03230240018008

To the Editor.—  In 1969, (208:1661, 1969) we called attention to divergent blood and lymph circulatory dynamics in patients with ascites from hepatic cirrhosis. It was suggested that a rapid splenic circulation might be the primary (although not necessarily exclusive) factor generating high portal pressure. Recently, we had the opportunity to restudy five years later the portal circulation in patient 1 in whom splenectomy led to prompt remission of ascites and hypersplenism.During the intervening years, she remained free of ascites while she followed a regular diet without diuretic drug medication. Chemical tests of liver function and hepatic histology remained unchanged. Compared to preoperative splenoportography five years earlier, the venous phase of celiac angiography revealed diminution in size of the originally markedly enlarged portal vein but continued excellent perfusion of the liver with portal blood (Figure). Hepatic wedge pressure, which had been 44 cm to 16 cm saline before and