To the Editor.—We took great interest in reading the account of ectopic varices in patients with portal hypertension by Wilson and his colleagues in the Archives (114:1158-1161, 1979). However, no evident mechanism for the development of ectopic varices has been proposed. Recently, we reported the case of a cirrhotic patient who had bleeding varices of the fourth portion of the duodenum.1 In this patient, as in 24 of the 45 reported cases of ectopic varices,1 abdominal surgery had been performed previously. This high prevalence suggests that previous abdominal surgery may play a major part in the development of ectopic varices in patients with portal hypertension. Ectopic varices might be related to the unusual portosystemic collateral circulation that develops through the adhesions resulting from abdominal surgery.
LEBREC D. Ectopic Varices in Patients With Portal Hypertension. Arch Surg. 1980;115(7):890. doi:10.1001/archsurg.1980.01380070076020
* * SCHEDULED MAINTENANCE * *
The JAMA Network Sites will be conducting routine maintenance from 10/20/2017 through 10/21/2017. During this window access to content and authentication may be intermittently available. The JAMA Store will be completely unavailable during the maintenance window.