TREATMENT of portal hypertension by establishing a decompressive shunt between the portal and systemic venous systems was initiated in 1943. Considerable evidence has since accumulated to indicate that the procedure effectively prevents recurrence of varix hemorrhage, the most common precipitating cause of liver failure in cirrhotic patients.* Nevertheless there is widespread belief that protection from bleeding is uncertain and that variceal rupture occurs again in a significant proportion of treated patients even though the anastomosis is patent. Should gastrointestinal hemorrhage recur, it is almost routinely inferred the varicosities are the source, especially when they are again demonstrable. Except for a few case references, authentication for this inference is lacking as applied to the direct portacaval type of anastomosis in contrast to that of the splenorenal variety. The latter type of venovenous union does not shunt sufficient blood in some patients adequately to decompress the engorged portal bed, and varix rebleeding
LIEBOWITZ HR. Gastrointestinal Hemorrhage After Portacaval Shunt: Recurrence in Patients With Cirrhosis of Liver After Portacaval Shunt. Arch Intern Med. 1965;115(3):273–279. doi:10.1001/archinte.1965.03860150017004
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