Venous Thrombosis is met with in about 4.5 per cent, of all cases of carcinoma of the stomach, and almost invariably occurs at a late period of the complaint, when the patient is confined to bed. It is most frequent when the gastric symptoms are comparatively latent and when the disease is accompanied by leuchaemia.
As a rule, the femoral, saphenous, or external iliac veins are chiefly affected, especially those of the left side; but sometimes the thrombotic mischief extends upwards from one vessel to another, or after a short interval the corresponding vessel of the opposite limb becomes occluded. Less frequently the subclavian, axillary, basilic, or external jugulars are involved, while in rare instances thrombi form in most of the superficial veins of the body (Osier and McCrae). Among those situated internally the inferior vena cava, the vena portae, the pulmonary, mesenteric, and renal veins are most often affected.
Thrombosis of a vein in a limb is usually accompanied by pain, and followed by oedema of the tissues and a blue colouration of the skin; but if the patient is extremely asthenic the process may be quite painless and the swelling only discovered by accident. Occlusion of the internal iliac vessels is sometimes associated with haemorrhage from the rectum.
Portal thrombosis gives rise to the rapid development of ascites, or, if free fluid already exists in the peritoneal cavity, its quantity is suddenly and greatly augmented. Occasionally it is found to be hemorrhagic, and the patient may pass bright blood with his evacuations. OEdema of the legs ensues from pressure of the fluid upon the inferior vena cava. Suppurative pylephlebitis is very rare, and in the case recorded by Wickham Legg it was accompanied by ascites, oedema of the legs, and difficulty of micturition. Renal thrombosis is indicated by hematuria, pain in the loin, and by a diminution in the amount of urine. Pulmonary embolism may ensue from the detachment of a clot from a peripheral vein or from the right side of the heart.
Arterial Thrombosis is comparatively rare and chiefly occurs in the femoral, popliteal, and cerebral vessels. Whipham has recorded a case in which thrombosis of the left femoral and popliteal arteries was followed by gangrene of the leg, and a similar condition of the liver and transverse colon has been observed from occlusion of the hepatic and colic arteries respectively (Cooper, Denonvilliers, Goullioud, and Mollard). In a case of pyloric cancer published by Flint the patient was suddenly attacked by blindness and paralysis of the right arm owing to thrombosis of the left middle cerebral, and in a similar one by Merklen there were right hemiplegia, aphasia, and loss of sensation on the affected side.
Venous thrombosis is probably due to the altered state of the blood and the great enfeeblement of the heart that accompany the later stages of carcinoma of the stomach. The greater liability of the veins of the left leg may be due to the pressure exerted upon the external iliac vein by an overloaded sigmoid flexure. Thrombosis of both femorals and iliacs usually indicates pressure upon the inferior vena cava. Trousseau was accustomed to regard thrombosis of a vein in the arm or leg in a case of gastric disease as pathognomonic of carcinoma, but its diagnostic value is less than was formerly believed. From the point of view of prognosis the occurrence of thrombosis may be held to indicate the near approach of the end, and the occlusion of a cerebral vessel as its immediate precursor.
Certain organs of the body are liable to become affected with chronic inflammation independently of the formation of secondary deposits in their substance.
Chronic Gastritis, both parenchymatous and interstitial, invariably accompanies carcinoma of the stomach, and is especially severe when the growth has given rise to obstruction of the pylorus. In these cases most of the early symptoms are due to the inflammatory state of the viscus.
Chronic Enteritis is encountered in a large proportion of the cases, though it seldom gives rise to any special symptoms. Occasionally, however, pain and diarrhoea occur towards the termination of the complaint, and after death a few superficial ulcers are found in the colon, or the intestinal mucous membrane presents signs of diphtheritic inflammation. These conditions are probably due to the long-continued retention and decomposition of the faeces.