Postmortale Darstellung des portalen Kollateralkreislaufes

Introduction

Postmortem investigation of esophageal varices and the portal system is difficult, because veins are collapsed at autopsy. The demonstration of varices is possible by illumination of the isolated mucous membrane or by puncturing esophageal varices and filling them with different materials.

Material and methods

We use a 15% aqueous gelatine solution (if needed with additional barium sulfate for x-ray examination) which is supplemented by 40% formaldehyde (40 ml in 1 l gelatine solution). The superior mesenteric vein is catheterized and filled by a clyster-pump.

Results

The mixture of gelatine and formaldehyde hardens within a few minutes. The autopsy is delayed only about half an hour. Within this time the portal system is well outlined. This method can show exactly the drainage of the portal system into the inferior vena cava. In cases of portocaval shunt or of esophageal transsection the result of the operation can be verified. The localization of the bleeding source of esophageal varices can be demonstrated by escape of the filling mass.