Treatment of bleeding esophagogastric varices due to extrahepatic portal hypertension: Results of portal-systemic shunts during 35 years

Orloff, Marshall J.; Orloff, Mark S.; Rambotti, Massimo

doi:10.1016/0022-3468(94)90309-3

Cited by 89 publications

(61 citation statements)

References 40 publications

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“…Rebleeding rates are low and seem to be equal for each type of anastamosis performed (end-to-side portacaval, side-to-side portacaval, splenorenal, distal splenorenal, or mesocaval). Orloff et al [30][31][32] have reported excellent results with portacaval shunting for acutely bleeding esophagogastric varices. Their 30-day survival rates of 85% and encephalophathy rates of 8-9% have not been duplicated by other authors [33].…”

Section: Gastric Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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Esophageal varices are the most common site of variceal bleeding. However, bleeding from varices that are not located in the esophagus may account for up to 30% of all variceal bleeding. Significant varices can occur in the stomach, duodenum, jejunum, ileum, colon, rectum, and biliary tree. They can also occur at the site of a surgical ostomy. These types of varices bleed less commonly than esophageal varices, but they can also be far more difficult to diagnose and treat. The absence of stigmata of recent esophageal variceal bleeding and certain clues in the patient’s history and clinical presentation should raise the clinician’s suspicion of an extraesophageal site of variceal bleeding. Particularly, patients with extrahepatic causes of portal hypertension, cirrhotic patients with a prior history of gastrointestinal surgery, and patients who present with profound bleeding but without hematemesis need to be evaluated further if an obvious site of esophageal variceal bleeding is not seen on initial endoscopy. In this article, we review the features particular to extraesophageal varices as well as the diagnosis and management of bleeding from these varices. We use the term extraesophageal rather than ectopic because the term ectopic varices implies exclusion of both esophageal and gastric varices.

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Section: Gastric Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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“…→ disorders (2-28 %), but in nearly 50% of the patients etiology remained unidentified [28][29][30][31][32] . But with the advent of better medical care, potent antibiotic treatment, advanced medical technology, discovery of various causes of genetic thrombophilia and with better understanding of the coagulation system, this profile has also changed.…”

Section: Figurementioning

confidence: 99%

REVIEWEtiology and consequences of thrombosis in abdominal vessels

Bayraktar

Harmancı²

2006

WJG

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The thrombophilia which can be either congenital or acquired in adult life has major implications in the abdominal vessels. The resulting portal vein thrombosis, Budd-Chiari syndrome and mesenteric vein thrombosis have a variety of consequences ranging from acute abdomen to chronic hepatomegaly and even totally asymptomatic patient in whom the only finding is pancytopenia. The complications like esophageal varices, portal gastropathy, ascites, severe hypersplenism, liver failure requiring liver transplantation are well known. Interesting features of collateral venous circulation showing itself as pseudocholangiocarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of intraabdominal vessel thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we presented and discussed the abdominal venous thrombosis, etiology and the resulting clinical pictures. There are controversial issues both in nomenclature, and management including anticoagulation problems and follow up strategies. In light of the current knowledge, we discussed some controversial issues in literature and presented our experience and our proposals about this group of patients.

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“…Although these shunts are effective in controlling variceal bleeding, encephalopathy is a concern in patients with poor liver functions. Follow up studies have shown shunt patency in 85-98% of children with long term survival in >95% cases (Lautz, 2009;Bismuth, 1980;Gauthier, 1989;Mitra, 1993;Prasad, 1994;Orloff, 1994;Superina, 2006;Shariff, 2010). Risk of variceal recurrence and rebleed is there in case of shunt blockage.…”

Section: Surgical Management Of Ehpvomentioning

confidence: 99%