To the Editor.—We read with great interest the article by Steiner and colleagues1 regarding hepatocellular carcinoma presenting with intractable diarrhea. Their patient's symptoms were attributed to the presence within the hepatocellular carcinoma tumor cells of vasoactive intestinal polypeptides, gastrin, and prostaglandinlike substances. This interesting and enlightening report reminded us of two cases in the past year of severe portal hypertension presenting with intractable diarrhea. In both cases, the diarrhea, which failed to respond to all of the usual treatment modalities, preceded the onset of variceal hemorrhage. In one of these patients, who subsequently underwent a mesocaval shunt for uncontrollable variceal hemorrhage, the small bowel was found at exploration to be extremely edematous, suggesting that passive congestion of the intestinal mucosa was responsible for the diarrhea. Following mesocaval shunting, his diarrhea subsided completely and has not recurred.
We would be interested in hearing about any other cases of severe