Emergency distal splenorenal shunts for variceal hemorrhage refractory to nonoperative control.

Two points are emphasized by this report. First, every attempt should be made to control acute variceal hemorrhage nonoperatively. Such control can be gained in about 80 percent of patients, allowing for a period of stabilization of liver disease, correction of coagulation defects, and nutritional repletion. Operative mortality then becomes equivalent to that in other elective candidates. Second, when necessary, because of ongoing hemorrhage in the face of maximal nonoperative therapy, selective shunting can be accomplished on an emergency basis. In our study, it resulted in a 70 percent survival rate and excellent protection against recurrent variceal hemorrhage with long-term maintenance of portal perfusion in 89 percent of the patients.