The Surgical Treatment of Portal Hypertension
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Portal hypertension remains to my mind one of the most obscure modern surgical problems in many of its aspects. Many of the clinical features of this disease are not capable of ready explanation. Why is it that patients with portal hypertension and bleeding from oesophageal varices seldom have bleeding from haemorrhoids? Why is it that patients who have oesophageal bleeding as a result of portal tension, and presumably a high portal pressure within the abdomen, do not at operation, when the contents of their abdomen are fully exposed to atmospheric pressure, present a cyanosed intestine and congestion and dilatation of the mesenteric venous trunks? It is said that the negative pressure within the thorax encourages dilatation of the unsupported oesophageal veins, yet in these cases, though the veins of the retroperitoneal space may be grossly dilated too.