HYPERTROPHIES OF THE SPLEEN.
Enlargement of the spleen occurs during numerous acute and chronic infections—e. g., typhoid, malaria—in connection with certain affections of the liver; in consequence of interstitial or gummatous forms of syphilis, with or without similar lesions in the liver; in acute peritoneal infections; in general septic and pyemic disturbances; in rickets and the status lymphaticus; in the various forms of leukemia, Hodgkin’s disease, and pseudoleukemia, and in that somewhat peculiar type known as Banti’s disease, or splenomegaly. In fact the spleen enlarges under so many conditions that its hypertrophy is an expression of a general infection rather than of any pronounced or particular type of the same. Minor degrees of enlargement have often passed unnoticed or given little or no trouble. When seriously overgrown its principal features are its inconvenience, weight, and size. The condition is recognized by its characteristic shape and notch (See above.) By its extension upward it can be usually distinguished from a tumor, of the kidney.
Every splenic enlargement, especially chronic, should lead to a careful blood examination, by which, among other things, malaria may be recognized or excluded, while the degree and form of leukemia, if present, may be estimated. The lymph nodes throughout the body should also be carefully examined. Splenomyelogenous leukemia, for example, is progressive, severe, and marked by cachexia and anemia of peculiar type. In many of these cases there is a tendency to hemorrhage, both from surfaces and into the tissues. The hemoglobin is much reduced and prognosis after any operation is unfavorable. (See chapters on the [Blood] and the [Lymphatic System].)
Banti’s disease, or splenomegaly, seems also a somewhat peculiar type of lesion which is probably due to an infection proceeding from the intestinal canal, and involving the liver in its later course. In its last stage there is a tendency to hepatic cirrhosis, with ascites, and hemorrhages in any part of the body are frequent.
Removal of the spleen for any of these conditions is usually a precarious procedure. It has been more successful when performed for malarial hypertrophy than for other conditions, the patient’s chances being then about three out of four; but here, too, the lesion is usually amenable to other treatment. If done in the early stages of Banti’s disease it would seem to be strongly indicated, but not in the later stages, when the liver is involved and the abdomen full of fluid. In the leukemias it has succeeded in a few instances. It is mostly indicated in those cases where hemorrhages occur early.
The Röntgen rays have recently been shown to have an excellent effect in many of these cases and are worthy of trial. Especially in the leukemic forms, in connection with arsenic internally, they offer probably the best prospects.
SPLENIC DISPLACEMENTS.
While, under ordinary circumstances, the supports of the spleen may seem equal to ordinary needs they prove insufficient in many cases of marked enlargement. Hence results displacement, or the so-called “wandering spleen,” which may be due to the results of injury, to tight lacing, possibly to congenital relaxation of ligaments, but mainly to hypertrophy, with increase in size and weight. When the spleen enlarges it descends toward the umbilicus, but it has even been found in the pelvis. As it prolapses it brings down with it the stomach and the pancreas, thus interfering with the circulation of all three organs and producing a train of distressing secondary consequences. A long-drawn-out splenic ligament may be much stretched and may even become finally twisted, thus causing gangrene of the spleen from torsion of its support. Moderate displacement and stretching produce discomfort, pain, and disturbance of function. Such a displaced spleen is to be recognized by its shape, size, and notch, and is occasionally to be distinguished from a wandering kidney. When displaced its normal location will not be dull upon percussion.
Treatment.
—Palliative treatment, which may be tried first, calls for whatever drugs may be needed to unload the bowels, but especially for rest in bed and support by suitable abdominal binder, with or without a pad. If the spleen itself be much enlarged it may also be subjected with a judicious frequency to the x-rays.