The Eck-Pavlov connection.

Abstract

In 1877, N. V. Eck described the surgical creation of a fistula between the inferior vena cava and the portal vein in a dog. At the same time he suggested that this operation might be of use in humans for the treatment of ascites. But it was not until more than 50 years later that A. O. Whipple's report of his experience with Eck's operation ushered in the so-called modern era of the portacaval shunt. While there has been sporadic reports about various phases of Eck's life, most reference books do not even give the date of his death, and some references disagree as to the date of his birth. He has been mistakenly placed among the physiologists rather than the surgeons of Russia, and while quoted as a "brilliant student," he has been accused of being "ill-suited" to his profession by the same source. For his intense interest in other areas such as mining and geology, he is depicted as an erratic man who sought something he probably never found. It is said that for 13 years he was divorced from medicine and surgery, when in fact it was during this period that he performed the only clinical portocaval shunt of his career (and it was successful). Unable to find answers to many questions concerning the 59 years of this man's life in the Western world, a recent trip to Leningrad by the author was informative, interesting, and even surprising. Eck's rarely quoted connection with I. P. Pavlov was more than just an acquaintance, and the famed "Eck-fistula" of the Western world is known as the "Eck-Pavlov shunt" in Leningrad.