Digestive Diseases and Sciences

, Volume 25, Issue 12, pp 929–938 | Cite as

Effect of portacaval anastomosis on hypersplenism

  • Milton G. Mutchníck
  • Emanuel Lerner
  • Harold O. Conn
Original Articles


Leukopenia, thrombocytopenia, and hemolytic anemia occur commonly in advanced cirrhosis. Some investigators have reported that portacaval anastomosis (PCA) abolishes hypersplenism while others have not found PCA to be uniformly beneficial. We compared the frequency of hypersplenism before and after admission to a controlled investigation of the effects of PCA in 52 unoperated control subjects and 38 patients with patent PCA. The two groups were followed for an average period of 51/2 years. On admission to the study leukopenia was present in about 2% of patients, thrombocytopenia in 6%, and hemolytic anemia in 4%. Splenomegaly was present in 48% and hypersplenism in 11%. After randomization splenomegaly disappeared more frequently in the shunted group. In addition, fewer patients with PCA developed splenomegaly for the first time after inclusion into the study than did unoperated control subjects. Leukopenia, thrombocytopenia, and hemolytic anemia, when present at inclusion into the study, disappeared with equal frequency in the shunted and unshunted patients, and appeared with equal frequency in both groups after randomization in previously unaffected patients. In no instance was hypersplenism clinically significant nor was splenectomy considered or carried out in any of these 90 patients. In additional uncontrolled studies we observed that therapeutic PCA did not affect hypersplenism differently from prophylactic PCA. We conclude that PCA has neither clinically nor statistically significant effects on hypersplenism.


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  1. 1.
    King RB: The blood picture in portal cirrhosis of the liver. A report based on 100 cases. N Engl J Med 200:482–484, 1929Google Scholar
  2. 2.
    Morlock CG, Hall BE: Association of cirrhosis, thrombopenia and hemorrhagic tendency. Arch Intern Med 72:69–77, 1943Google Scholar
  3. 3.
    Berman L, Axelrod AR, Horan TN, Jacobson SD, Sharp EA, VonderHeide EC: The blood and bone marrow in patients with cirrhosis of the liver. Blood 4:511–533. 1949Google Scholar
  4. 4.
    McDermott WV Jr, Palazzi H, Nardi GL, Mondel A: Elective portal systemic shunt. An analysis of 237 cases. N Engl J Med 264:419–427. 1961Google Scholar
  5. 5.
    Rousselot LM, Panke WF, Bono RF, Moreno AH: Experiences with portacaval anastomosis. Analysis of 104 elective end-to-side shunts for the prevention of recurrent hemor-rhage from esophagogastric varices (1952 through 1961). Am J Med 34:297–307, 1963Google Scholar
  6. 6.
    Burchell AR, Rousselot LM, Panke WF: A seven-year experience with side-to-side portacaval shunt for cirrhotic ascites. Ann Surg 168:655–670, 1968Google Scholar
  7. 7.
    Felix WR Jr, Myerson RM, Sigel B, Perrin EB, Jackson FC: The effect of portacaval shunt on hypersplenism. Surg Gynecol Obstet 139:899–904, 1974Google Scholar
  8. 8.
    Buligesco L, Popovici A, Bogathy I, Cutcudache C: L'hypersplenisme et l'hypertension portale. Acta Gastroenterol Belg 38:361–372, 1975Google Scholar
  9. 9.
    Hutson DG, Zeppa R, Levi JU, Schiff ER, Livingstone AS, Fink P: The effect of the distal splenorenal shunt on hyper-splenism. Ann Surg 185:605–612, 1977Google Scholar
  10. 10.
    MacPherson AIS, Innes J: Peripheral blood picture after operation for portal hypertension. Lancet 1:1120–1123, 1953Google Scholar
  11. 11.
    Ekman C-A: Portal hypertension. Diagnosis and surgical treatment. Acta Chir Scand (Suppl) 222:1–143, 1957Google Scholar
  12. 12.
    Sullivan BH Jr, Tumen HJ: The effect of portacaval shunt on thrombocytopenia associated with portal hypertension. Ann Intern Med 55:598–603, 1961Google Scholar
  13. 13.
    Crane C: The choice of shunt procedure for cirrhotic patients with variceal bleeding, ascites, and hypersplenism. Surg Gynecol Obstet 115:12–28, 1962Google Scholar
  14. 14.
    Morris PW, Patton TB, Balint JA, Hirschowitz BI: Portal hypertension, congestive splenomegaly, and portacaval shunt. Gastroenterology 42:555–559, 1962Google Scholar
  15. 15.
    Schreiber HW: Klinische und tierexperimentelle Untersuchungen zum verhalten der splenpathischen Blutzelldepression Hypersplenismus) nach Durchfuhrung einer portocavalen Anastomose. Langenbecks Arch Klin Chir 300:669–691, 1962Google Scholar
  16. 16.
    Gerwig WH Jr, Countryman LK, Harrison I, Keshishian JM: Persistent hypersplenism following portacaval shunt. W Va Med J 59:179–182, 1963Google Scholar
  17. 17.
    Liebowitz HR: Splenomegaly and hypersplenism pre- and post-portacaval shunt. NY State J Med 63:2631–2638, 1963Google Scholar
  18. 18.
    Redetzki JE, Bickers JN, Samuels M, Sekinger DJ: Progressive hypersplenism after portacaval anastomosis. Report of 3 cases. Am J Dig Dis 12:88–97, 1967Google Scholar
  19. 19.
    Conn HO, Lindenmuth WW, May CJ, Ramsby GR: Prophylactic portacaval anastomosis. A tale of two studies. Medicine 51:27–40, 1972Google Scholar
  20. 20.
    Conn HO: Portacaval anastomosis and hepatic hemosiderin deposition: A prospective, controlled investigation. Gastroentrology 62:61–72, 1972Google Scholar
  21. 21.
    Phillips MM, Ramsby GR, Conn HO: Portacaval anastomosis and peptic ulcer: A nonassociation. Gastroenterology 68:121–131, 1975Google Scholar
  22. 22.
    Mutchnick MG, Lerner E, Conn HO: Portal-systemic encephalopathy and portacaval anastomosis: A prospective, controlled investigation. Gastroenterology 66:1005–1019, 1974Google Scholar
  23. 23.
    Conn HO: Therapeutic portacaval anastomosis: To shunt or not to shunt. Gastroenterology 67:1065–1071, 1974Google Scholar

Copyright information

© Plenum Publishing Corporation 1980

Authors and Affiliations

  • Milton G. Mutchníck
    • 1
    • 2
  • Emanuel Lerner
    • 1
    • 2
  • Harold O. Conn
    • 1
    • 2
  1. 1.Deparment of Internal MedicineVeterans Administration Medical CenterWest Haven
  2. 2.Yale University School of MedicineNew Haven

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