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Although probably most surgeons prefer to establish continuity of the intestinal tract by end-to-end anastomosis after resection or division of the bowel, still a considerable number of surgeons continue to establish side-to-side anastomoses. In addition to the usual complications which may follow end-to-end anastomoses, side-to-side anastomoses may produce a series of complications if the proximal segment of the bowel distal to the anastomosis is excessive. Dilatation and hypertrophy of this segment may develop, resulting in a gradually enlarging pouch which may progress to ulceration and perforation. As early as 1906 Cannon and Murphy 1 observed, in cats, that the proximal segment of a side-to-side anastomosis failed to empty properly if a redundant segment were left beyond the site of anastomosis. Estes and Holm, 2 in 1932, and Pearce, 3 in 1937, using dogs, demonstrated that when peristalsis was towards the blind proximal segments of bowel distal to a side-to-side anastomosis

THE ORIGINAL operation of portacaval shunt was first successfully carried out by von Eck in 1877. 1 Since that time, sporadic operations have been performed, 2 but results were discouraging and the operative death rate prohibitive. Today this operation may safely be recommended for properly selected patients. 3 Advances in anesthesiology have contributed much to the safety of this procedure, and adequate administration of blood and fluid, preoperatively, postoperatively and more particularly during the operative procedure, have further secured that safety. Proficiency in the execution of anastomoses between delicate and friable veins is essential, and the surgeon must master these skills in the experimental laboratory before attempting to perform the procedures in human beings. The two cases presented in this report are illustrative of some of the technical difficulties which may be encountered in attempting to perform a portacaval shunt. REPORT OF CASES Case 1. —E. B. (St. Lukes, no.