Treatment of Bleeding Esophageal Varices After Splenectomy

For many years the combination of splenomegaly, bleeding from esophageal varices, and sometimes cirrhosis of the liver was given the eponym "Banti's syndrome." It was taught that the primary disease was splenic and that disease of the liver developed subsequently. In 1936¹ and 1937,² Whipple, Rousselot, and their associates confirmed the long-standing suspicion that such patients had elevated pressure in the portal venous system. In 1941 and later, Whipple * noted that cirrhosis of the liver did not develop in all such cases and that in cases in which cirrhosis was absent extrahepatic obstruction was demonstrable in the portal system. Establishing the concept in use today, Whipple concluded that portal hypertension and its sequelae of congestive splenomegaly and esophagogastric varices develop as a result of obstruction to the outflow of blood from the portal system. He suggested that patients with this disorder be classified into two groups according to