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
PRESTON FW, TRIPPEL OH. Emergency Portacaval Shunt: Use in Patients With Alcoholic Cirrhosis. Arch Surg. 1965;90(5):770–781. doi:10.1001/archsurg.1965.01320110106018
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