[Idiopathic portal hypertension]

The authors present a report of 14 patients with the syndrome of portal hypertension without liver cirrhosis and with recurring esophagogastric bleedings. The cause of the alterations in portal hemodynamics remains unknown. Operative treatments (splenorenal shunts in 9 cases, 3 splenectomies and 1 ligation of the splenic artery) were successful. Two patients in whom splenectomy had been performed in combination with omentohepatopexy died 6 and 10 years after operation due to recurrent hemorrhages. The other patients did not have recurrent bleedings, but in 6 patients 6-10 years after splenorenal shunts there appeared other diseases (encephalopathy, nephrolithiasis, arterial hypertension, duodenal ulcer). The authors consider that indications for shunting operations for idiopathic portal hypertension, especially when using renal veins, should be determined more carefully, phlebosclerotic therapy and transsection of the esophagus being recommended as alternative interventions.