Abstract
The records of 2,377 patients with Laennec's cirrhosis were reviewed for the period 1947-1957. The chief presenting symptom was ascites in 46 per cent, bleeding in 23 per cent, coma in 18 per cent, jaundice in 9 per cent, and both jaundice and ascites in 4 per cent. Nearly half of the patients died during the period under study—one-third from hepatic failure, one-third from gastrointestinal bleeding, and one-third from other causes, most of which were related to alcoholism.
Massive gastrointestinal bleeding occurred in 21 per cent of the patients at some time in their clinical course, and in the 10 per cent of these in whom ulcer was demonstrated, one-fifth died as a result of the hemorrhage. Of those presumed to be bleeding from esophageal varices, 64 per cent died at the first hemorrhage and 10 per cent at subsequent hemorrhages; 85 per cent of all those who bled from varices were dead at the end of one year, and 91 per cent were dead at the end of three years.
The survival curve of a group of patients who bled once and were good operative risks but had received no operative treatment was compared to the survival curve for entire group who survived the first hemorrhage. The three-year survival in the good risk group was 47 per cent; for the group as a whole it was 30 per cent. The difference in mortality rate was primarily due to an increased number of deaths from hepatic failure in the combined group, whereas 60 per cent of the good risk group died of recurrent gastrointestinal hemorrhage.
As 86 per cent of those who were to die of gastrointestinal bleeding did so at the first hemorrhage, it was concluded that any decided improvement in the salvage rate achievable by operation must come from some means of diagnostic forecast of the likelihood of bleeding, with resort to prophylactic operation in such cases.
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Selected References
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- BAKER L. A., SMITH C., LIEBERMAN G. The natural history of esophageal varices; a study of 115 cirrhotic patients in whom varices were diagnosed prior to bleeding. Am J Med. 1959 Feb;26(2):228–237. doi: 10.1016/0002-9343(59)90311-0. [DOI] [PubMed] [Google Scholar]
- CHASE G., MARTEL C., OLIVETTI R. Analysis of causes of death in Laennec's cirrhosis. Am J Med Sci. 1957 Mar;233(3):259–263. doi: 10.1097/00000441-195703000-00003. [DOI] [PubMed] [Google Scholar]
- CHILD C. G., 3rd The portal circulation. N Engl J Med. 1955 May 19;252(20):837–850. doi: 10.1056/NEJM195505192522002. [DOI] [PubMed] [Google Scholar]
- COHN R., BLAISDELL F. W. The natural history of the patient with cirrhosis of the liver with esophageal varices following the first massive hemorrhage. Surg Gynecol Obstet. 1958 Jun;106(6):699–701. [PubMed] [Google Scholar]
- DOUGLASS B. E., SNELL A. M. Portal cirrhosis; an analysis of 444 cases with notes on modern methods of treatment. Gastroenterology. 1950 Jul;15(3):407–425. [PubMed] [Google Scholar]
- HALLENBECK G. A., COMESS M. S., WOLLAEGER E. E., GAGE R. P. Bleeding varices due to cirrhosis; survival after (1) nonsurgical treatment, (2) splenectomy with or without omentopexy, and (3) portacaval and splenorenal shunts. AMA Arch Surg. 1959 May;78(5):774–785. [PubMed] [Google Scholar]
- LINTON R. R. The selection of patients for portacaval shunts, with a summary of the results in 61 cases. Ann Surg. 1951 Sep;134(3):433–443. doi: 10.1097/00000658-195109000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- LIPP W. F., LIPSITZ M. H. The clinical significance of the co-existence of peptic ulcer and portal cirrhosis, with special reference to the problem of massive hemorrhage. Gastroenterology. 1952 Oct;22(2):181–191. [PubMed] [Google Scholar]
- NACHLAS M. M., O'NEIL J. E., CAMPBELL A. J. The life history of patients with cirrhosis of the liver and bleeding esophageal varices. Ann Surg. 1955 Jan;141(1):10–23. doi: 10.1097/00000658-195501000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SHEEHY T. W. Relation of hemorrhage from varices to mortality in cirrhosis. Am J Dig Dis. 1957 Apr;2(4):195–209. doi: 10.1007/BF02231128. [DOI] [PubMed] [Google Scholar]
- SWISHER W. P., BAKER L. A., BENNETT H. D. Peptic ulcer in Laennec's cirrhosis. Am J Dig Dis. 1955 Oct;22(10):291–294. doi: 10.1007/BF02886060. [DOI] [PubMed] [Google Scholar]
- TAYLOR F. W., JONTZ J. G. Cirrhosis with hemorrhage. AMA Arch Surg. 1959 May;78(5):786–790. doi: 10.1001/archsurg.1959.04320050117017. [DOI] [PubMed] [Google Scholar]