Diagnosis of Extrahepatic Portal Vein Obstruction

Abstract

To the Editor.— In a recent article by Yale and Crummy entitled "Splenic Vein Thrombosis and Bleeding Esophageal Varices," the value of splenoportography and transarterial portography was emphasized in the preoperative evaluation of patients with bleeding gastroesophageal varices to allow identification of extrahepatic or segmental portal hypertension. 1 The authors correctly pointed out that the proper treatment of patients with extrahepatic portal obstruction should include splenectomy. In their excellent article, however, the authors did not mention another angiographic study, umbilical vein portography. The following case report is abstracted from previous papers. 2,3 Report of a Case.— A 58-year-old man was admitted because of massive hematemesis and melena. Marked splenomegaly was present, but the liver was not enlarged. Aside from leukocytosis, laboratory values, including liver-function tests, were within normal limits. An x-ray film series of the upper-gastrointestinal tract disclosed large esophageal, gastric, and duodenal bulb varices. A duodenal ulcer was suspected.