Abstract
Esophageal bleeding is apparenly one of the most serious complication of portal hypertension, It may be prevented surgically, but indication of operation must be carefully evaluated. This is especially true in a case of cirrhosis of liver, in whom indication should be determined on the basis of histological pattern of the liver, degree of portal hypertension and splenoportographic finding.
In this clinic, for preoperative evaluation of cirrhotic patients with esophageal varices, under a small, left subcostal incision of abdominal wall biopsy of the liver, splenoportography and measurement of portal venous pressure are made. The findings of these together with the results of liver function tests and general condition, provide of basis for determining indication and type of surgery.
In this report, a case, 54 years of age, having portal cirrhosis of liver histologically with esophageal varices, in whom the varices were successfully not evidenced after the splenorenal-shunt (Inokuchi), is described.
In this procedure an autogenous vein graft taken from the right iliac vein is interpolated between the splenic and renal vein, The features of splenorenal-shunt (Inokuchi) are that the anastomotic stoma is large and the anastomotic juncture angle is made acute by utilizing the physiologic juncture angle of bifurcating veins.
Portal venous pressure of the patient was decreased from 470mm H2O to 230mm H2O after the shunting, and that was controlled to 300mm H2O under partial tucking of splenic vein.
In the patient presented blood ammoniac levels rose to 0.4mg % and total serum protein content fell also to 5.5g. % postoperatively, but was returned to normal levels afterwards, and then no hepatic coma was resulted.
Liver function tests were not deteriorated, but preferably B S P retention, C C F test and serum albumine levels got better postoperatively, 40 days after the splenorenal-shunt (Inokuchi), esophageal varices of the patient could not be evidenced by fluoloscopy.
