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September 1957

Coma with Increased Amino Acids of Brain and Cerebrospinal Fluid in Dogs with Eck's Fistula: Prevention By Portal-Systemic Collateral Circulation

Author Affiliations

Rochester, Minn.
Section of Biochemistry (Drs. Bollman and Flock); Section of Surgical Research (Dr. Grindlay); Section of Physiology (Mr. Bickford), Mayo Clinic and Mayo Foundation. Fellow in Surgery, Mayo Foundation (Dr. Lichtenheld). The Mayo Foundation, Rochester, Minn., is a part of the Graduate School of the University of Minnesota.

AMA Arch Surg. 1957;75(3):405-412. doi:10.1001/archsurg.1957.01280150095010

Portacaval anastomosis with diversion of all the portal blood from the liver (Eck's fistula) in dogs is followed by characteristic symptoms and death within a year. A similar surgical procedure performed on humans for the relief of bleeding esophageal varices does not produce similar symptoms. In this study we show that symptoms do not follow this operation in the dog if portal-systemic collateral circulation is present. Since the presence of excessive portal-systemic collateral circulation is one of the chief indications for this operation in man, the absence of symptoms similar to those of animals with Eck's fistula also may be related to this collateral circulation.

The course and symptoms in animals with Eck's fistula were described adequately more than 60 years ago by Hahn and associates.1 In our experience, the same symptoms have prevailed. If all the portal blood is diverted from the liver to the vena cava in