الفهرس | Only 14 pages are availabe for public view |
Abstract This prospective randomized study included 90 active variceal bleeders out of 190 patients (47%) presenting with upper gastrointestinal hemorrhage at Riyadh Central Hospital in Saudi Arabia during the period September 1985 to February 1987 inclusive. They were assigned at random to either injection sclerotherapy or emergency esophageal transection : with splenectomy and gastric devascularization within the first 24 hours after admission. There were 76 males and 14 females whose ages ranged from 10 to 85 years, 17 of whom previously subjected to either sclerotherapy or surgical interference. They consisted of two equal groups of 45 patients each. Liver biopsy in 86 cases showed schistosomal hepatic fibrosis in ~8 patients, non-bilharzial cirrhosis in 24 and mixed cirrhosis in 11. In addition, 2 patients had hepatocellular carcinoma and one case had portal vein thrombosis with normal liver parenchyma. In the sclerothetapy series, the bleeding episode was the first attack in 30 cases and 33 patients were graded Child’s A or B. The initial endoscopic grading was IV in 18 patients, III in. 14 and II ’in 13. In the transection series, the bleeding episode was the first attack in 24 and 36 cases belonged Child’s A or B groups. Emergency endoscopy showed grade IV avarices. |