The following case of chronic occlusion of the portal vein by an old organized and canalized thrombus is reported because (1) few articles have appeared in English on this subject, (2) the condition is rarely diagnosed clinically, usually being mistaken for cirrhosis of the liver, Banti's disease or ulcer of the stomach, and (3) in this case an unsuspected and unusual collateral circulation defeated the anticipated result of a successful splenectomy, which in any other case would have been the logical treatment.
The patient was an obese white woman 34 years of age. Two years before admission to the hospital she vomited about 1 quart (1 liter) of bright red blood. Since that time hematemesis accompanied with epigastric pain which radiated "from the back" had recurred at intervals of from three to four months. She fainted during two of these attacks. The last attack occurred about one month before her