1989 Volume 31 Issue 12 Pages 3264-3273
Trans-ileocolic obliteration (TIO), performed urgently to control bleeding from ruptured gastric varices (GV) locating in the fornix in two patients, achieved complete hemostasis. The common features in two, demonstrated on trans-ileocolic portography, were as follows; a) marked dialatation of the left and/or short gastric veins in diameter, suggesting increase in blood flow of the gastric varices, and b) presence of the gastro-renal shunt as a solitary drainage vein of the gastric varices. Therefore, endoscopic injection sclerotheraphy (EIS) with a ordinary dosage of sclerosant expected to have little effect on hemorrhage. In addition, application of EIS for the gastric varices might lead obliteration of the shunt and an elevation of the venous pressure in the left and short gastric veins. Consequently, bleeding would persist after EIS. On the other land, application of TIO for the patients with the hemodynamic changes descrebed above was reasonable because the inflow collateral veins, i, e. the left and short gastric veins, were obliterated by the procedure. Actually, the gastric varices in two patients desappeared following TIO. We conclude that TIO for the patients with ruptured gastric varices locating in the fornix is safe and accurate as an emergent therapeutic modality.
