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AMA Arch Surg. 1950;61(4):667-676. doi:10.1001/archsurg.1950.01250020673007.
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IN RECENT years, through the work of such men as Whipple, Blakemore, Blalock and others,1 the construction of an artificial connection between the portal and systemic venous circulations as originally described by Eck2 has been accepted as a method of treatment of portal hypertension. In order to obtain a shunt of adequate size, most surgeons believe that either a direct portacaval or a splenorenal anastomosis should be performed. The type of operation utilized varies with the requirements of the specific case.

This investigation concerns itself with the situation in which the indications for the construction of the fistula are present but in which neither procedure is technically possible. Previous splenectomy, for all intents and purposes, precludes the construction of a splenorenal shunt. Though attempts have been made to isolate the stump of the splenic vein after removal of the spleen, these efforts generally have been fruitless. Similarly, a


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