In surgical patients, the _thrombotic form_ is almost invariably met
with in the lower extremity, and usually occurs in those who are
debilitated and anaemic, and who are confined to bed for prolonged
periods--for example, during the treatment of fractures of the leg or
pelvis, or after such operations as herniotomy, prostatectomy, or
appendectomy.
_Clinical Features._--The most typical example of this form of phlebitis
is that so frequently met with in the great saphena vein, especially
when it is varicose. The onset of the attack is indicated by a sudden
pain in the lower limb--sometimes below, sometimes above the knee. This
initial pain may be associated with shivering or even with a rigor, and
the temperature usually rises one or two degrees. There is swelling and
tenderness along the line of the affected vein, and the skin over it is
a dull-red or purple colour. The swollen vein may be felt as a firm
cord, with bead-like enlargements in the position of the valves. The
patient experiences a feeling of stiffness and tightness throughout the
limb. There is often oedema of the leg and foot, especially when the limb
is in the dependent position. The acute symptoms pass off in a few days,
but the swelling and tenderness of the vein and the oedema of the limb
may last for many weeks.
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