INFLAMMATION OF THE PORTAL VEIN PYLEPHLEBITIS. 683 



or removing the shrunken connective tissue by iodine or mercurial 

 preparations, and consequently are limited to a symptomatic treatment. 



CHAPTER V", 



INFLAMMATION OP THE PORTAL VEJX PYLEPHLEBITIS. 



ETIOLOGY. By pylephlebitis we understand not only those con- 

 ditions where an inflammation of the wall of the vein induces a clot in 

 the portal vein, but also those where coagulation of the contents of 

 the portal vein occurs independently of inflammation in the walls of 

 the vessel. 



The first form primary phlebitis is far rarer than the latter. Its 

 exciting causes are partly injuries of the portal vein, partly inflamma- 

 tion of the parts about it, which extends to the wall of the vein. 



Secondary phlebitis, or, as it is now called, thrombus of the portal 

 vein, cannot always be referred to any evident causes : 1. In some 

 cases it is due to compression of the trunk of the portal vein, by lym- 

 phatic glands, caseously or cancerously degenerated, or by thickened 

 or cicatricially contracted peritonaeum. 2. In other cases, compression 

 of the branches of the portal vein, as by cirrhosis, so retards the cur- 

 rent of the blood, that coagula form in the trunk or ramifications of 

 the portal vein. 3. It appears to result much more frequently from the 

 gradual increase and extension of a thrombus that has formed in some 

 branch of the portal vein. In the same way, where there is thrombus 

 of one of the crural veins, not unfrequently a clot occurs not only in 

 the vein of the corresponding leg, but the thrombus often extends up- 

 ward also into the vena cava, or even into the renal veins. In such 

 cases there is a primary thrombosis in the portal vein and its branches, 

 even when the original coagulum in one of the roots of the portal 

 vein resulted from inflammation of its walls. In this way are most 

 readily explained the thromboses of the portal vein, due to ulcerations 

 and suppurations in the abdomen, to inflammation of the umbilical 

 vein in newly-born children, to abscesses of the spleen, ulcers of the 

 stomach, to inflamed and suppurating luemorrhoidal tumors, and to 

 similar causes. 4. It has not been determined whether emboli, from 

 collections of pus reaching the liver, can give rise to a coagulum at 

 first circumscribed, subsequently diffuse, in the portal vein. 



ANATOMICAL APPEARANCES. In the first stage of both forms 

 of pylephlebitis there is always coagulation of the contents of the 

 vein. It is important to note this, to avoid error : suppurative phle- 

 bitis begins with suppuration in the vein. The clot adheres firmly 

 to the wall of the vein. In primary phlebitis this is from the first 



