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December 1978

'Downhill' Esophageal VaricesA Rare Cause of Upper Gastrointestinal Bleeding

Arch Surg. 1978;113(12):1463-1464. doi:10.1001/archsurg.1978.01370240085016

• The submucosal venous network of the esophagus is part of the collateral system that develops following superior vena caval obstruction from any cause. The direction of flow in these thin-walled, valveless veins is "downhill," towards the azygous vein or to the inferior vena cava. Bleeding from upper esophageal varices is extremely rare. This case report describes a patient with massive bleeding from upper esophageal varices secondary to superior vena caval obstruction by a malignant thyroid tumor. Total thyroidectomy relieved the obstruction, with cessation of hemorrhage and subsequent disappearance of the varices.

(Arch Surg 113:1463-1464, 1978)