A case of a mesocaval shunt placed urgently in a 52-year-old man to control life-threatening hemorrhage from esophageal varices is reported. The latter resulted from portal hypertension secondary to Laennec's cirrhosis. The patient suffered from acute and chronic alcoholism, but not alcoholic hepatitis. Twenty-three years later, the shunt is angiographically patent; the patient is alive and well. He has been free from encephalopathy with the exception of three episodes of gastrointestinal hemorrhage secondary to peptic ulcer disease. In each case, hepatic coma responded promptly to cathartics, enemas, and lactulose once bleeding ceased.
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