Postmortem Demonstration of Esophageal Varices by a Simple Method

Abstract

The usual methods available to demonstrate esophageal varices in postmortem material have met with little success because of their unreliability, difficulty to execute, or cost. A simple, inexpensive method, which consists in separating the esophageal mucosa and submucosa from the muscularis and stretching the former over a suitable absorbent paper, is described. In a few minutes, as the adherent membrane dries, the submucosal vascular pattern gradually develops, and after overnight drying, even the smallest venules are clearly visible. The specimen can be stored dry, photographed, or made into a more permanent preparation in a few days. The esophageal mucosal vascular patterns in groups of patients who died with a variety of hepatic diseases and other potential causes of esophageal varices were studied and compared with controls. A consistent pattern of prominent venous trunks located towards the distal third of the esophagus was seen in most specimens from cirrhotic patients, predominantly in micronodular forms with severe lobular distortion. Other potential causes of esophageal varices (hepatic tumors, congestion, etc.) resulted in less predictable vascular patterns.