Treatment of Esophageal Varices in Children

Able, Luke W.
November 1970
American Journal of Gastroenterology;Nov1970, Vol. 54 Issue 5, p453
Academic Journal
Gastroesophageal tamponage, local hypothermia, intravenous pituitrin, and transfusions have been effective in the emergency treatment of variceal hematemesis and melena. Selective intraarterial vasopressin should be even more effective. Esophagoscopy, multiple portal pressure, and cin&ecute;venograms were valuable surgical guides. Varices are cured by the permanent establishment of a large-flow portacaval, mesenteric, or splenorenal shunt that reduces all the portal system pressure to normal. Whenever the establishment of such a large-flow is impractical, bleeding can be controlled or successfully palliated by suture obliteration of the varices together with gastric transection and splenic transposition; this is effective at any age. In this series colon interposition was utilized only for stricture and fistula, it proved a relatively simple and effective procedure. Should bleeding recur at a later date further variceal suturing may be extended, colon interposition, or better, if repeat splenovenograms can now demonstrate a fortuitously enlarged vein, a curative shunt can be established.


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