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A Rare Cause of Upper Gastrointestinal Bleeding

L. Stephen Johnson, MD; Douglas G. Kinnear, MD; Rea A. Brown, MD; David S. Mulder, MD

Arch Surg. 1978;113(12):1463-1464.

Abstract
• The submucosal venous network of the esophagus is part of the collateral system that develops following superior vena caval obstruction from any cause. The direction of flow in these thin-walled, valveless veins is "downhill," towards the azygous vein or to the inferior vena cava. Bleeding from upper esophageal varices is extremely rare. This case report describes a patient with massive bleeding from upper esophageal varices secondary to superior vena caval obstruction by a malignant thyroid tumor. Total thyroidectomy relieved the obstruction, with cessation of hemorrhage and subsequent disappearance of the varices.

(Arch Surg 113:1463-1464, 1978)

Author Affiliations
From the Departments of Medicine (Drs Johnson and Kinnear) and Surgery (Drs Brown and Mulder), Montreal General Hospital, McGill University, Montreal.

Footnotes
Accepted for publication April 17, 1978.

Reprint requests to Montreal General Hospital, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada (Dr Mulder).

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