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August 14, 1954


JAMA. 1954;155(16):1426-1427. doi:10.1001/jama.1954.03690340048011

Pegot, in 1833, observed a patient who on examination had dilated, tortuous veins on the abdominal wall with formation of a caput medusae and an audible murmur over the dilated veins on auscultation. Necropsy by Cruveilhier on the same patient in 1852 revealed a small noncirrhotic liver, a large spleen, and a patent umbilical vein. Cruveilhier considered the fundamental lesion in this case to be a congenital patency of the umbilical vein. This patency could be caused by the maintenance after birth of an abnormal communication between the umbilical vein and the epigastric veins. Such an anastomosis would permit the blood to be shunted away from the liver and lead to atrophy of the organ. In 1908 Baumgarten reported a somewhat similar case in a 16-year-old boy who died from massive gastric hemorrhage. There were distended abdominal veins, an enlarged spleen, ascites, and leukopenia. Necropsy revealed a small atrophic liver

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