Management of Bleeding From Esophageal Varices
THE goal of treatment of portal hypertension and bleeding esophageal varices is the control of hemorrhage and the prevention of its recurrence. Publications have dealt chiefly with the selection of cases, operative mortality, and technical matters of interest to those entrusted with definitive treatment, but have not elaborated upon two important points: (1) the practical measures that may be taken by the general practitioner who sees the patient first, and (2) the effectiveness of the various operative procedures in preventing recurrent bleeding.
This discussion is presented in the belief that it is the initial treatment of the cirrhotic patient with bleeding varices that largely determines whether or not he will survive a bleeding episode and recover to the extent that surgical measures may be safely undertaken to prevent recurrent hemorrhage. A program of management is outlined which may be carried out rapidly, is adaptable to the community hospital, and offers the patient a maximum opportunity for survival.
The Problem in the Bleeding Cirrhotic Patient
The high mortality associated with gastrointestinal bleeding in cirrhotic patients is well known. Approximately one quarter to one half of any group of cirrhotic patients will bleed each year, and the mortality due to hemorrhage is from 25 to 75 per cent. Half of those who survive will bleed again within the year with a mortality of 50 per cent.1,2 The reserve of the damaged liver is easily compromised by shock, anoxia, severe infection, or the presence of a large amount of blood in the intestinal. . .