Abstract
Twenty patients with liver cirrhosis were treated by surgery for bleeding from isolated gastric varices. The presence of tortuous and engorged gastric veins connecting with a large splenorenal shunt was demonstrated by transhepatic portography in all patients. The surgical procedures consisted of splenectomy, proximal gastrectomy, paragastric devascularization, and ligation of the splenorenal shunt. Sixteen patients survived the surgery. Four deaths were caused by emergency operation for uncontrollable hemorrhage in extremely poor risk patients. Of the 16 survivors, 15 had been followed wth endoscopy and portography for a mean period of 42 months. The other one died of hepatocellular carcinoma three years after surgery. There was no bleeding episode during the period of follow-up in these patients. Recurrent esophageal varices of mild degree were documented by endoscopy and portography in three patients. Portography demonstrated that several newly formed retroperitoneal veins arising from the junction of the portal and superior mesenteric veins joined to form recurrent varices in these three patients. There was no significant change of the mean portal venous pressure before and after surgery. Our data reveals that elective surgery may provide satisfactory results in patients with isolated gastric varices. Transhepatic portography is the method of choice in radiologic investigation for prominent gastric varices.
Highlights
In patients with liver cirrhosis the development of esophagogastric varices has been well recognized
The technique for transhepatic portography has been described in more detail in the literature In all patients a selective splenic venogram was initially obtained to evaluate the patency of the splenic vein, the presence of gastric varices and the flow direction of the splenorenal shunt
Two patients had left subphrenic abscess due to extravasation of the pancreatic juice which was caused by pancreatic tail injury during splenectomy
Summary
In patients with liver cirrhosis the development of esophagogastric varices has been well recognized. Prominent gastric varices without esophageal varices which are termed isolated gastric varices (IGV) or fundal varices could be found in a small proportion of patients[1,2,3]. In such patients with IGV, portographic study usually delineates tortuous and engorged gastric veins with a large spontaneous splenorenal or gastrorenal shunt draining into inferior vena cava[4]. Every patient with bleeding gastric varices was given vasopressin soon after admission to our unit. Fifteen patients were able to control bleeding with these treatments. Five required an emergency procedure due to failure of our medical measures and uncontrollable hemorrhage
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