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September 1948

ESOPHAGEAL VARICESTwo Cases with Different Surgical Approach

Arch Surg. 1948;57(3):391-395. doi:10.1001/archsurg.1948.01240020397010

ESOPHAGEAL varices with repeated severe hemorrhages are due usually to varying degrees of portal vein obstruction. The increased portal vein pressure forces blood into the esophageal veins. The veins in the submucosa of the esophagus are poorly supported by loose connective tissue. Thus varicosities may develop. The sucking effect of respiration accentuates this.

There is evidence that Banti's syndrome of splenomegaly, anemia, leukopenia and esophageal varices, with hemorrhage and at times ascites, is due not to primary disease of the spleen but rather to varying degrees of obstruction in the portal system. Whipple1 and his co-workers, by blocking the portal vein experimentally, were able to produce Banti's syndrome. The term "congestive splenomegaly" suggested by Larrabee in 1934 is more descriptive of this condition.

Portal hypertension may be due to intrahepatic or extrahepatic block. The former is usually the result of cirrhosis. Extrahepatic block may be due to fibrous

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