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Aron Mashiah, MD
Kaplan Hospital Rehovot, Israel

JAMA. 1981;246(20):2323-2324.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The article by Johansen et al (1980;244:2084) reports an instance of massive bleeding from hemorrhoidal varices in portal hypertension. We would like to suggest an alternative way of treating such a condition, by means of cryosurgery and without any anesthesia.

Report of Cases.—CASE 1.—

A 61-year-old man with known alcoholic cirrhosis, portal hypertension, ascites, and esophageal varices was admitted to our hospital because of weakness and rectal bleeding. For several months before admission he had suffered daily rectal bleeding, with blood loss serious enough to cause a fall in his hematocrit value to 18% to 20%, and on several occasions he had needed blood replacement. A physical examination showed three groups of edematous and dilated rectal varices, one of which bled easily on anoscopy. With the patient in the left lateral position, and without any premedication or anesthetic, cryosurgery was performed, using a nitrous oxide . . . [Full Text PDF of this Article]

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