Hemorrhage from esophageal varices after placement of the LeVeen shunt

Transient bleeding from esophageal varices was noted in a patient with alcoholic cirrhosis and a patent end-to-side portacaval shunt after placement of a LeVeen shunt for unmanageable ascites. Pressure measurements of the portal systemic gradient, obtained at the time of bleeding and 12 days later, suggest that the variceal hemorrhage was induced by the rapid infusion of ascitic fluid into the systemic circulation. Principles of management for variceal hemorrhage after LeVeen shunt placement are discussed.