CASE HISTORY

1955: Ascites, jaundice and anorexia appeared and a provisional diagnosis of cirrhosis was made. 1957: The patient investigated at another hospital. Clinical diagnosis: cirrhosis of liver. 1958 massive haematemesis, controlled by blood transfusion. Investigated at this hospital found to have oesophageal varices and a gastric ulcer. A liver biopsy confirmed the cirrhosis. Remained well until April 1959 when he had a massive haematemesis. He was admitted to hospital but the haemorrhage could not be controlled and he died. At postmortem the liver weighed 1370g and showed a regular cirrhosis with nodules averaging about 0.8cm. Death was due to massive haemorrhage and the stomach contained about a litre of fresh blood.

PATHOLOGY

Two specimens have been mounted, the lower oesophagus and a piece of the stomach. The oesophagus is dilated. If it is held up to the light numerous dilated varices are seen and a little above the middle of the specimen in the site of the rupture and at this point there is some local haemorrhage. It is worth noting that oesophageal varices collapsed after death and are very much smaller in the specimen than they appear in life. The second specimen is a piece of the stomach and it shows innumerable small superficial erosions of the mucosa. Each erosion is filled with altered blood which gives it a black appearance.