Gastric varices.

Abstract

The purpose of this paper is to describe the roentgen appearance of gastric varices, to define other abnormal changes from which they must be distinguished, and to re-emphasize the frequency of their occurrence along with esophageal varices in portal hypertension. The medical literature prior to 1928 contains many references to postmortem reports of esophageal and gastric varices. Stadelmann (10), in 1913, reported on 2 patients with exsanguinating hemorrhage from gastric varices. The first antemortem demonstration of esophageal varices by roentgenologic methods was achieved in 1928 by Wolf (12). Shortly following this there were further reports on the roentgenographic appearance of both esophageal and gastric varices by Schatzki (9), Brdiczka and Tschakert (1), Eisler (2), and Pape (5). The latter two authors showed that large varices may produce contour changes and filling defects of the fundus of the stomach similar to those caused by a neoplasm. Gastric varices have received much less attention in the literature than their esophageal counterparts. The two types of varices usually coexist in chronic hypertension of the portal system, and the term “gastroesophageal” is aptly applied to these cases. Phemister and Humphreys (7), in a report of 2 cases of gastroesophageal varices secondary to Banti's disease, state that under certain conditions the gastric component may provide a greater danger of hemorrhage than the esophageal. These authors attribute the lack of emphasis on gastric hemorrhage associated with gastroesophageal varices to the fact that bleeding may occur without gross erosions. Hence, the source is not readily diagnosed roentgenologically or postmortem. The venous drainage of the upper third of the stomach begins in the capillary plexuses around the gastric glands. These plexuses unite to form a network throughout the submucosa from which branches pierce the muscular coat and unite to form the following veins: the right gastroepiploic, which joins the superior mesenteric; the left gastroepiploic, which drains into the splenic vein; the vasa breva or short gastric veins (usually four or five in number), which drain the fundus of the stomach and empty into the splenic vein; the coronary vein, which runs along the lesser curvature, drains the cardia, and usually empties into either the portal or splenic vein. The coronary vein forms an anastomotic plexus with the venous network about the distal esophagus. These latter veins drain into the hemiazygos, which in turn drains into the caval system (Fig. 1). The above-mentioned veins contain numerous valves, competent in the child but rarely so in the adult (6). Portal cirrhosis causes varying degrees of disturbance of liver function, but the most prominent effects are the result of obstruction to the portal circulation.