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November 1973

Hepatic Venous Obstruction and Bile Flow-Reply

Author Affiliations

Brooklyn, NY

Arch Surg. 1973;107(5):816. doi:10.1001/archsurg.1973.01350230167032

To the Editor.—Donovan et al are, of course, justified in pointing out that the experimental methods employed by them1 and by us2 were entirely different. Perhaps, as they suggest, there is no reason for comparing them at all.

One cannot quibble with the markedly increased bile flows measured by Lenthall et al3 in seven patients with severe, parenchymal liver disease. This suggests increased bile flow in liver disease with presumed hepatic congestion, although only one of these seven patients exhibited ascites at laparotomy, and then only a minimal amount (300 ml).

We maintain that, in their animal study, Donovan and his colleagues failed to document one important proof of hepatic congestion—ascites. We have personally made the error of estimating constriction of the vena cava to 50% of original diameter, only to find later that the constriction was too little (no ascites) or too much (the dog

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