Venous bypass for decompression of bleeding varices of the pharynx

Abstract

Bilateral radical neck dissection results in major morbidity when both jugular veins are ligated. Reported complications include massive facial edema, airway obstruction, and increased intracranial pressure. We describe a case in which a previously unreported complication of bleeding pharyngeal varices was encountered. The problem was successfully managed by decompressing the neck veins with a venous bypass using a transposition of the cephalic vein.

Pharyngeal Varices Secondary to Sinistral Portal Hypertension

“…Pharyngeal varices are extremely rare, and have been reported in only 2 cases. 1 , 2 Sinistral portal hypertension is caused by thrombosis or obstruction of the splenic vein, resulting in back pressure changes in the left portal system, and mostly leads to the formation of gastric varices. A minority of gastric varices form the gastrocaval shunt that drains via the upper branch of the inferior phrenic vein into the inferior vena cava.…”