Rodin Number: 36
E Number: 141
Date: c 1881
Size (H x W cm): 17 x 12
The specimen consists of a portion of liver (L) with attached gall bladder (G). The blue glass rod is most likely in the vena cava; however, its orientation with respect to the hepatic hilum is unusual. It is difficult to appreciate the obliterated portal vein (possibly, as Rodin suggests, it has been reduced to a thin cord near the hilum (arrow)).
Click on caption to enlarge image.
Osler published an account of the case in the Journal of Anatomy and Physiology in 1882. The patient was a 28 year-old man admitted to the Montreal General Hospital in June 1881 because of “extreme exhaustion” following the vomiting of blood. This occurred several more times until his death about one week later. Osler found significant enlargement of the spleen as well as “dilated and tortuous gastric veins”, consistent with portal vein obstruction. The liver was “small” but did not show features of cirrhosis. He gives a highly detailed account of the abdominal veins, which includes a description of the portal vein being “obliterated from a point 2 cm beyond its origin and converted into an irregular, fibrous cord …”.
In his discussion of the case, Osler indicated that “the (pre-mortem) diagnosis was not easy… (and lay)… between cirrhosis of the liver, splenic anemia, and an aneurysm". He conceded that the cause of the obliteration was unclear but likely related to thrombosis followed by organization into fibrous tissue.