The effect of prolonged withdrawal of endogenous stimuli to gastric secretion

Abstract

1965). This procedure entails simple digital fracture of the occluding membrane which is approached through the right atrium. However, from the experience of the cases described here it is apparent that this is not always feasible. Moreover, if the membrane is not excised, there is always the possibility of re-stenosis. In Case I complete obstruction of the inferior vena cava recurred 4 years after the membrane had been split and dilated.The ideal procedure would therefore seem to be excision of the membrane under direct vision, with the aid of cardiopulmonary by-pass. The inferior vena cava should be drained by a catheter introduced into the femoral vein and advanced to the site of the obstruction. The superior vena cava should be drained by a catheter introduced via the right atrium and arterial perfusion effected by cannulating the femoral artery. The occluding membrane may then be visualized by opening the right atrium. Palpation of the drainage catheter in the inferior vena cava will give accurate assessment of the thickness of the obstructing membrane. It should then be possible to cut down on the drainage catheter and to excise the membrane with little risk of perforation of the inferior vena cava. SUMMARYFour cases of membranous obstruction of the hepatic segment of the inferior vena cava are described.The clinical presentation and problems of surgical management are discussed.Addendum.-Since submitting this paper for publication we have encountered a 35-year-old Bantu female with recurrent varicose ulceration of the legs. Several unsuccessful operations had been performed in an attempt to cure the varicosities. Angiography revealed membranous obstruction of the hepatic segment of the inferior vena cava. The membrane was successfully resected under cardiopulmonary bypass as described in the text.