Clinical Study on Treatment of Ruptured Varices on the Fornix of the Stomach

Hiroshi Toriya, Shigeaki Yoshimura, Kensei Maeshiro, Takuji Tago, Zentaro Shirai, Sumitaka Arima, Hiroshi Kokawa*, Katsuhiko Kubara*, Kouichi Nakaoka*, Youichi Oyama*, Hideo Tokumitsu*, Masatoshi Okazaki**

The First Department of Surgery, The First Department of Internal Medicine* and The Department of Radiology**, School of Medicine, Fukuoka University

The clinical features of 17 patients with ruptures of varices on the fornix of the stomach (FV) were studied. In 12 of the 17 patients (70.6%), tumorous FV could be demonstrated endoscopically, as compared with 23.5% and 5.9% for nodular and flat elevated FV respectively. As the initial treatment, endoscopic injection sclerotherapy (EIS) was performed in 4 patients, transileocolic obliteration (TIO) in 7, and Hassab's operation (HB) in 6. The rates of hemostasis after these treatment were 25%, 43% and, 100%, respectively. Ten of the 17 patients obtained permanent hemostasis after the initial treatment. Secondary treatment for variceal rebleeding was carried out in the other 7 patients; EIS in one, TIO in 4, and HB in 2. The rates of hemostasis were 0%, 50% and 100% respectively, and permanent hemostasis was accomplished in 4 of these 7 patients. In 2 of 3 patients with further variceal rebleeding, hemostasis was accomplished by EIS or HB. The cumulative hemostatic rates were 33%, 45% and 100% for patients who received EIS, TIO and HB, respectively. No postoperative variceal rebleeding was observd after HB. Consequently progressive prophylactic treatment by HB is recommended, especially for tumorous FV or nodular FV, in order to improve the prognosis for patients with ruptured FV. It is also important to develop new obliterating agents or techniques so that defenite hemostasis can be achieved even in patients considered to be inoperable.

Key words
rupture of the fundic varices, emergency treatment for ruptured fundic varices, endoscopic classification of the fundic varices

Reprint requests
Hiroshi Toriya The First Department of Surgery, School of Medicine, Fukuoka University
7-45-1 Nanakuma, Jyonan-ku, Fukuoka City, 814-01 JAPAN

Accepted
January 8, 1992

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