The Bleeding Gullet

"The Sengstaken tube was removed from the esophagus today at noon, and . . . there is no evidence of recurrent bleeding." The surgical jargon in the report on General of the Army Douglas MacArthur, by distinguished doctors at the Walter Reed Army Medical Center, covered not only what had ailed the patient but also an ingenious device to relieve the trouble.

When circulation through the liver is blocked by disease, the blood backs up into the veins lining the gullet (esophagus) and sometimes the stomach as well. The swollen, twisted veins are called varices. Their thin walls are prone to break and let blood ooze, or even gush, into the digestive tract. To squeeze the veins shut and thus stop the bleeding, two New York surgeons, Dr. Robert W. Sengstaken and Dr. Arthur H. Blakemore, devised a most ingenious triple tube.

The innermost tube (see diagram) goes into the stomach so that any escaped blood can be suctioned off. The second, with a balloon on its end, goes just inside the stomach, where it is inflated to serve as an anchor. The third chamber is a sausage-shaped balloon nine inches long, which is inflated in the gullet. Its pressure against the varices stops the bleeding.

Though the Sengstaken-Blakemore tube is effective in many cases, most surgeons and all patients hate it. It is inserted through the nose, which is most uncomfortable, and the inflated balloon itself is painful. If left in place too long, the balloon can become ulcer-producing, so it must be deflated after about 24 hours. The patient cannot swallow saliva or other secretions, so a cut is usually made into the windpipe for drainage. Understandably, the tube is used only in case of real emergencies.

This file is automatically generated by a robot program, so reader's discretion is required.