Abstract PORTAL hypertension associated with gastroesophageal hemorrhage constitutes a perplexing problem and a particularly difficult one from the point of view of clinical management. It has been the subject of intensive study in recent years, especially from the standpoint of its role in treatment of venous shunts made between the portal and vena caval systems.1 Because certain aspects of the disorder may differ in children and in adults and because of the paucity of recorded data relating specifically to the management of portal hypertension in children, we have been led to report our own observations. This study is concerned with an analysis of the fate of portal hypertension associated with gastroesophageal hemorrhage in 21 patients whose symptoms began before the age of 15. In all but one definitive treatment was started at 14 or an earlier age. During the period covered, one additional child was admitted to the hospital with References 1. (a) Blakemore, A. H.: Portacaval Anastomosis: A Report on 14 Cases , Bull. New York Acad. Med. 22:254, 1946 2. (b) Portacaval Anastomosis for the Relief of Portal Hypertension , Gastroenterology 11:488, 1948 3. (c) Portacaval Anastomosis—Observations on Technic and Postoperative Care , S. Clin. North America 28:279, 1948. 4. (d) Blalock, A.: The Use of Shunt or By-Pass Operations in the Treatment of Certain Circulatory Disorders Including Portal Hypertension and Pulmonic Stenosis , Ann. Surg. 125:129, 1947.Crossref 5. (e) Julian, O. C., and Dye, W. S.: Venous Shunts in Portal Hypertension , A. M. A. Arch. Surg. 63:373, 1951.Crossref 6. (f) Linton, R. R.; Jones, C. M., and Volwiler, W.: Portal Hypertension: The Treatment by Splenectomy and Splenorenal Anastomosis with Preservation of the Kidney , S. Clin. North America 27:1162, 1947. 7. (g) Linton, R. R.: The Surgical Treatment of Bleeding Esophageal Varices by Portal Systemic Venous Shunts with a Report of 34 Cases , Ann. Int. Med. 31:794, 1949.Crossref 8. Linton, R. R.: The Selection of Patients for Portacaval Shunts , Ann. Surg. 134:433, 1951.Crossref 9. Barg, E. H., and Dulin, J. W.: Splenectomy in the Treatment of Banti's Syndrome , Arch. Surg. 41:91, 1940.Crossref 10. Costello, C.: Massive Hematemesis: An Analysis of 300 Consecutive Cases , Ann. Surg. 129:289, 1949.Crossref 11. Rousselot, M.: The Late Phase of Congestive Splenomegaly (Banti's Syndrome) With Hematemesis but Without Cirrhosis of the Liver , Surgery 8:34, 1940. 12. Lahey, F. H., and Narcross, J. W.: Splenectomy: When Is It Indicated? Ann. Surg. 128:363, 1948.Crossref 13. Cole, W. H.; LeRoy, W., and Limarzi, L. R.: Indications and Results of Splenectomy , Ann. Surg. 129:702, 1949. 14. Pemberton, J. DeJ., and Kiernan, P.: Surgery of the Spleen , S. Clin. North America 25:880, 1945. 15. Phemister, D. B., and Humphreys, E. M.: Gastroesophageal Resection and Total Gastrectomy in the Treatment of Bleeding Varicose Veins in Banti's Syndrome , Ann. Surg. 126:397, 1947Crossref 16. Blakemore, A. H., and Fitzpatrick, H. F.: The Surgical Management of the Post-Splenectomy Bleeder with Extrahepatic Portal Hypertension , Ann. Surg. 134:420,. 1951.Crossref 17. Schafer, P. W., and Kittle, F. C.: Partial Esophagogastrectomy in the Treatment of Esophagogastric Varices , Arch. Surg. 61:235, 1950.Crossref 18. Gray, H. K., and Whitesell, F. B., Jr.: Hemorrhage from Esophageal Varices , Ann. Surg. 132:798, 1950.Crossref 19. Gray, H. K., and Whitesell, F. B., Jr.: Hemorrhage from Esophageal Varices: Surgical Management , Ann. Surg. 132:798, 1950.Crossref 20. Baronofsky, I. D.: Portal Hypertension: With Special Reference to Acid-Peptic Factor in Causation of Hemorrhage and Extensive Gastric Resection in Its Treatment , Surgery 25:135, 1949. 21. Blakemore, A. H., and Fitzpatrick, H. F.: The Surgical Management of the Post-Splenectomy Bleeder with Extrahepatic Portal Hypertension , Ann. Surg. 134:420, 1951.Crossref
A.M.A. Archives Surgery – American Medical Association
Published: Oct 1, 1952
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