Extrahepatic portal venous obstruction, although rare in the western world, is a common cause of major and life threatening upper gastrointestinal
bleeding among the poor in developing countries. Patients have large spleens and
stunted growth. The diagnosis is easily confirmed by Doppler ultrasonography. Endoscopy
sclerotherapy is the best option for the control of acute variceal
bleeding. For secondary prophylaxis of
bleeding, the choice lies between repeated
sclerotherapy and a
portosystemic shunt. We believe that due consideration should be given to performing a
splenectomy and a lienorenal shunt. Performed by experienced surgeons, it carries a low operative mortality of 1%, a rebleeding rate of about 10%, removes the large spleen, reverses
hypersplenism, and is not followed by
portosystemic encephalopathy. Most importantly, it is a onetime procedure particularly suited to those who have little access to
blood transfusion and sophisticated medical facilities.