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December 1967

The Potential Hazard of Pregnancy in Extrahepatic Portal Hypertension: Report of Two Cases

Author Affiliations

From the Department of General Surgery, The Cleveland Clinic Foundation, Cleveland. Dr. Esselstyn is now at the Womack Army Hospital, Fort Bragg, NC.

Arch Surg. 1967;95(6):956-959. doi:10.1001/archsurg.1967.01330180104019

PORTAL hypertension may result from either intrahepatic or extrahepatic obstruction of the portal venous system. Intrahepatic narrowing of the portal venous radicles occurs in cirrhosis of the liver, and this disease accounts for the great majority of cases of portal hypertension in adults. Extrahepatic thrombosis or cavernous transformation of the portal vein is a less common cause of portal hypertension in adults, but is the cause in almost half of the patients who are children. This type of portal hypertension has been treated by various surgical procedures, the two most effective being portalsystemic shunt operations5 or direct ligation of the varices.1,4 Shunt operations decompress the portal venous system, while the direct ligation of varices occludes the dangerous area of collateral flow.

We have had the unique opportunity at the Cleveland Clinic to follow the progress of 14 patients with extrahepatic portal hypertension who underwent transthoracic, transesophageal ligation of

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