The Portal Venous Pressure in Man

Abstract

Mall 1 , 2 appears to have been the first to record the portal venous pressure in animals under experimental conditions. The later determinations by Burton-Opitz 3 , 4 , 5 were shortly followed by Tiger-stedt's 6 records. These observers used the technically difficult T-cannulation of the portal vein, although this itself probably interfered with the normal pressure under investigation. In the experimental animal, we 7 have employed cannulation of the divided inferior mesenteric vein, cannulation of a divided splenic vein (as suggested by Bayliss and Starling), and T-cannulation of the portal vein itself. The height of a column of physiologic saline solution above the portal vein sustained in a vertical tube attached to the cannula was taken as the portal pressure. In our animal, the portal pressure was always about 10 cm saline higher than the venous pressure simultaneously determined in the lower extremity. This communication is intended to record a series of portal venous pressures determined at laparotomy in man.

Rousselot 8 measured the portal venous pressure in 4 patients with Bantis' syndrome of congestive splenomegaly without cirrhosis and observed the presence of portal hypertension—the pressures varying between 330 and 465 mm.

Method. A modification of the method of Griffith, Chamberlain, and Kitchell 9 was used. The manometer consists essentially of a vertical glass tube with a T-cock at the lower end mounted on a firm base. One horizontal limb of the cock permits filling the manometer with saline to a level above the expected venous pressure. The other limb is attached by sterile rubber tubing to a glass adapter and hypodermic needle which are filled with saline solution. With the abdomen open, the needle is inserted into an omental vein by the surgeon, whereupon the T-cock is turned by the observer to allow the vertical manometer to communicate with the vein.