Abstract
A 29-year-old woman with idiopathic portal hypertension was referred to our department for the surgical management of repetitive bleeding from esophageal and gastric varices. At the age of 16 years she had undergone a splenectomy with esophageal transection followed by endoscopic sclerotherapy which had been performed a total of 24 times. Although vericeal hemorrhage was prevented for several months, bleeding from gastric varices and portal hypertensive gastropathy was not able to be controlled readily by endoscopic sclerotherapy from when she was 26 years old. On admission, angiographic studies showed a complete obstruction of the portal vein; however, a portosystemic shunt operation was not able to be performed due to her previous splenectomy. To control her repetitive bleeding, we decided to perform a total gastrectomy and distal esophagectomy with reconstruction by a Roux-en-Y esophagojejunostomy. Her postoperative course was uneventful, and no episodes of recurrent bleeding or other complications have developed, indicating that her quality of life has dramatically improved. Thus, we conclude that distal esophagectomy and total gastrectomy constitute an effective surgical treatment for unshuntable extrahepatic portal hypertension.
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Orloff MJ, Orloff MS, Daily PO, Girard B (1994) Long-term results of radical esophagogastrectomy for bleeding varices due to unshuntable extrahepatic portal hypertension. Am J Surg 167:96–103
Warren WD, Henderson JM (1988) Management of variceal bleeding in patients with noncirrhotic portal vein thrombosis. Ann Surg 207:623–634
Fonkalsrud EW (1974) Surgical management of portal hypertension in children. Arch Surg 115:1042–1045
Fonkalsrud EW, Myers NA, Robinson MJ (1974) Management of extrahepatic portal hypertension in children. Ann Surg 180:487–493
Boles Jr ET, Wise Jr WE, Briken G (1986) Extrahepatic portal hypertension in children: Long-term evaluation. Am J Surg 151:734–739
Foster JH, Holcomb GW, Kirtley JA (1963) Results of surgical treatment of portal hypertension in children. Ann Surg 157:868–881
Shalon S, Sherlock S (1962) Obstruction to the extrahepatic portal system in childhood. Lancet 1:63–67
Bernstein EF, Varco RL, Wangensteen OH (1969) Treatment of bleeding esophageal varices in portal-systemic shunt failures. Arch Surg 99:171–178
Habif DV (1959) Treatment of esophageal varices by partial esophagogastrectomy and interposed jejunal segment. Surgery 46:212–235
Rothwell-Jackson RL, Hunt AH (1970) Proximal gastric resection in the treatment of bleeding gastro-oesophageal varices in patients with portal hypertension due to extrahepatic obstruction. Br J Surg 57:487–494
Voorhees Jr AB, Price Jr JB (1974) Extrahepatic portal hypetension: A retrospective analysis of 127 cases and associated clinical implications. Arch Surg 108:338–341
Koop CE, Roddy SR (1958) Colonic replacement of distal esophagus and proximal stomach in the management of bleeding varices in children. Am Surg 147:17–25
Koop CE, Kavianian A (1965) Reappraisal of colonic replacement of distal esophagus and proximal stomach in the management of bleeding varices in children. Surgery 57:454–456
Trusler GA, Morris FR, Mustard WT (1962) Portal hypertension in childhood. Surgery 52:664–670
Cooley DA, DeBakey ME (1954) Subtotal esophagectomy for bleeding esophageal varices. Arch Surg 68:854–871
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Hirao, T., Ko, S., Kanehiro, H. et al. Radical esophagogastrectomy for unshuntable extrahepatic portal hypertension with bleeding varices: Report of a case. Surg Today 27, 243–246 (1997). https://doi.org/10.1007/BF00941653
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DOI: https://doi.org/10.1007/BF00941653