The aim of this work was to study the portacaval shunts described by Sappey in the falciform ligament of the liver in the cirrhotic patient. Twenty men and 8 women (mean age: 63 years) were studied by ultrasonography. Ascites was present in 20 patients. Venous anastomoses through the falciform ligament were visualized in 16 of the 28 patients. When present, they were usually multiple (1 to 4) with a diameter of about 10 mm. In 8 patients, a large communication with one of the main portal branches was seen. In the same patients, gastroesophageal shunts were always present but umbilical and splenorenal anastomoses were found only in 3 and in 4 patients respectively. This emphasizes the importance of such shunts which are in part intrahepatic. Ultrasonic exploration of these shunts should be routine in the evaluation of collateral circulation in cirrhosis.
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