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The fundal pile: bleeding gastric varices.
J Pediatr Surg. 1991 Jun; 26(6):707-9.JP

Abstract

Bleeding from esophageal varices is a common cause of major upper gastrointestinal tract blood loss in children with portal hypertension but usually ceases spontaneously or is satisfactorily managed by nonoperative measures. Massive hemorrhage from gastric fundal varices may be difficult to control with compression and sclerotherapy; in these cases, a direct surgical approach may be indicated. Since 1984, 27 children have undergone aggressive injection sclerotherapy for bleeding esophageal/gastric varices. Nine (6 with portal vein thrombosis) bled from gastric fundal varices. In 5 of these, medical management and sclerotherapy failed to control the acute bleed. In all 5 there was "rupture" of a large gastric fundal varix or "pile" and bleeding was controlled at emergency laparotomy by underrunning the varices through a high anterior gastrotomy. Four have subsequently been successfully managed by continued sclerotherapy and one patient with cirrhosis has died of liver failure. In 3 of the survivors both esophageal and gastric fundal varices have been completely obliterated. No further life-threatening hemorrhage has occurred in any case during a follow-up period of 1 to 5 years. Bleeding from gastric varices is more common than previously recorded and more difficult to control by nonoperative management, including injection sclerotherapy. In uncontrolled hemorrhage from gastric varices, surgical underrunning offers a means of providing initial control. Thereafter, the inevitable variceal recurrence may be successfully treated with sclerotherapy.

Authors+Show Affiliations

Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

1941462

Citation

Millar, A J., et al. "The Fundal Pile: Bleeding Gastric Varices." Journal of Pediatric Surgery, vol. 26, no. 6, 1991, pp. 707-9.
Millar AJ, Brown RA, Hill ID, et al. The fundal pile: bleeding gastric varices. J Pediatr Surg. 1991;26(6):707-9.
Millar, A. J., Brown, R. A., Hill, I. D., Rode, H., & Cywes, S. (1991). The fundal pile: bleeding gastric varices. Journal of Pediatric Surgery, 26(6), 707-9.
Millar AJ, et al. The Fundal Pile: Bleeding Gastric Varices. J Pediatr Surg. 1991;26(6):707-9. PubMed PMID: 1941462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The fundal pile: bleeding gastric varices. AU - Millar,A J, AU - Brown,R A, AU - Hill,I D, AU - Rode,H, AU - Cywes,S, PY - 1991/6/1/pubmed PY - 1991/6/1/medline PY - 1991/6/1/entrez SP - 707 EP - 9 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 26 IS - 6 N2 - Bleeding from esophageal varices is a common cause of major upper gastrointestinal tract blood loss in children with portal hypertension but usually ceases spontaneously or is satisfactorily managed by nonoperative measures. Massive hemorrhage from gastric fundal varices may be difficult to control with compression and sclerotherapy; in these cases, a direct surgical approach may be indicated. Since 1984, 27 children have undergone aggressive injection sclerotherapy for bleeding esophageal/gastric varices. Nine (6 with portal vein thrombosis) bled from gastric fundal varices. In 5 of these, medical management and sclerotherapy failed to control the acute bleed. In all 5 there was "rupture" of a large gastric fundal varix or "pile" and bleeding was controlled at emergency laparotomy by underrunning the varices through a high anterior gastrotomy. Four have subsequently been successfully managed by continued sclerotherapy and one patient with cirrhosis has died of liver failure. In 3 of the survivors both esophageal and gastric fundal varices have been completely obliterated. No further life-threatening hemorrhage has occurred in any case during a follow-up period of 1 to 5 years. Bleeding from gastric varices is more common than previously recorded and more difficult to control by nonoperative management, including injection sclerotherapy. In uncontrolled hemorrhage from gastric varices, surgical underrunning offers a means of providing initial control. Thereafter, the inevitable variceal recurrence may be successfully treated with sclerotherapy. SN - 0022-3468 UR - https://www.unboundmedicine.com/medline/citation/1941462/The_fundal_pile:_bleeding_gastric_varices_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0022-3468(91)90015-L DB - PRIME DP - Unbound Medicine ER -