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May 1965

Emergency Portacaval Shunt: Use in Patients With Alcoholic Cirrhosis

Author Affiliations

From the departments of surgery, Veterans Administration Research Hospital and Northwestern University Medical School. Professor of Surgery, Northwestern University Medical School (Dr. Preston) and Associate Professor of Surgery Northwestern University Medical School (Dr. Trippel).

Arch Surg. 1965;90(5):770-781. doi:10.1001/archsurg.1965.01320110106018

UNDER most circumstances the treatment of choice for patients with alcoholic cirrhosis who experience life threatening hemorrhage from esophageal or gastric varices is immediate tamponade of the bleeding varix with a Sengstaken-Blakemore tube, blood replacement, and later an elective portacaval or splenorenal shunt. Under ideal circumstances the acute bleeding episode is followed by a period of abstinence from alcohol, and medical management which reduces edema and ascites, improves hepatic function and puts the patient in suitable condition to undergo a major operation.

In some patients hemorrhage from varices cannot be adequately controlled by nonoperative means even for short periods of time. In a few, Sengtaken balloon tamponade does not control the bleeding even temporarily. In others it controls it temporarily, and rebleeding takes place when the balloon is deflated, or recurs at intervals necessitating frequent occasions of balloon tamponade. Each episode of variceal hemorrhage is accompanied by further deterioration in