RADICAL ESOPHAGOGASTRECTOMY FOR UNSHUNTABLE EXTRAHEPATIC PORTAL-HYPERTENSION WITH BLEEDING VARICES - REPORT OF A CASE

A 29-year-old woman with idiopathic portal hypertension was referred t o our department for the surgical management of repetitive bleeding fr om esophageal and gastric varices, At the age of 16 years she had unde rgone a splenectomy with esophageal transection followed by endoscopic sclerotherapy which had been performed a total of 24 times. Although vericeal hemorrhage was prevented for several months, bleeding from ga stric varices and portal hypertensive gastropathy was not able to be c ontrolled readily by endoscopic sclerotherapy from when she was 26 yea rs old. On admission, angiographic studies showed a complete obstructi on of the portal vein; however, a portosystemic shunt operation was no t able to be performed due to her previous splenectomy. To control her repetitive bleeding, we decided to perform a total gastrectomy and di stal esophagectomy with reconstruction by a Roux-en-Y esophagojejunost omy. Her postoperative course was uneventful, and no episodes of recur rent bleeding or other complications have developed, indicating that h er quality of life has dramatically improved, Thus, we conclude that d istal esophagectomy and total gastrectomy constitute an effective surg ical treatment for unshuntable extrahepatic portal hypertension.