INJURIES TO THE SPLEEN.
The spleen may be injured by itself or along with other viscera. The most common injury is from contusion, which produces more or less disintegration or rupture and hemorrhage. The organ is so friable that it may literally burst under a comparatively slight force, other conditions being favorable. Doubtless minor degrees of these injuries pass unnoticed or are followed by some local peritonitis and adhesions. On the other hand the spleen may be actually fragmented, with necessarily fatal consequences unless promptly operated. Rupture is especially likely to occur after those infectious diseases which cause its enlargement—e. g., typhoid.
In case of injury there is, in addition to the history, a prompt location of pain in the region of the spleen, with signs of intra-abdominal hemorrhage, but without blood in the urine; perhaps with tumor or dulness on percussion, and always with abdominal rigidity, all of which point to the serious nature of the injury and demand exploratory section. Should this reveal a slight injury it may be repaired with ligatures or sutures. More serious tears or perforations are treated by gauze packing through a sufficiently open wound, while the most serious cases of pulpifaction call for complete extirpation. When the blood supply of the spleen is left in doubt its total removal will be far the safer course to adopt. Obviously such an operation should include examination of all the viscera and a careful toilet of the peritoneum.
ABSCESS OF THE SPLEEN; SUPPURATIVE SPLENITIS.
Pus may form within the spleen in consequence of septic infarcts or thrombosis, or it may be due to the extension of trouble from adjoining foci, or to pyemic metastasis. Splenic abscesses are usually localized, but the pyemic forms are always multiple, miliary at first, but coalescing into larger collections, and practically destroying the organ if the patient live long enough. The infectious fevers may be followed by suppuration of the spleen, which is also known to occur rarely in malaria.
Symptoms.
—The symptoms of splenic abscess are indeterminate until the capsule is involved and a perisplenitis—i. e., a local peritonitis—results, after which pain becomes severe. These collections occasionally discharge spontaneously into the colon or even into the stomach.
On general principles any abscess which can be located, even somewhat vaguely, should be attacked. After the abdomen is opened, preferably through the left semilunar line, the exploring needle may be used, especially if adhesions be present.
GANGRENE OF THE SPLEEN.
Gangrene of the spleen is the result of a still more rapid, otherwise similarly septic or thrombotic process, or of severe injury, by which circulation is practically cut off. It is a condition which rarely permits of any surgical help, though if it could be foreseen it might be prevented by an early splenectomy.