Dislocation of the Spleen.

Synonym.—Floating Spleen.

Definition.—The term dislocated spleen, is applied to the organ when, from some one or more of the various causes, it moves from its natural moorings, but remains fixed; while the term floating spleen is applied to a dislocated spleen that is movable.

Etiology.—The condition may be congenital or acquired. It may be due to an abnormal length, to stretching or tearing its ligaments by increased weight of the organ, by tight lacing, to traumatism, or to relaxation and stretching of the abdominal walls, so common in pregnant women.

Pathology.—The dislocated spleen has been found in various parts of the abdomen and pelvis, the most frequent place being the left iliac region, against the crest of the ilium; when in this position, the left flexure of the colon occupies the vacated space.

The spleen is generally greatly hypertrophied, especially when the displacement is due to engorgement from malaria or leukemia. Where there is impaired arterial circulation- the nutrition of the organ is deficient, giving rise to atrophy of the spleen, a rare condition.

Symptoms.—The symptoms are rather vague and are mostly due to pressure upon surrounding organs; thus where adhesions to the bladder or rectum have taken place, there will be tenesmus of these parts. If the pressure be upon the spinal nerves at their point of exit from the spinal column, there will be perverted sensation and sometimes paralysis.

As the result of the dislocation, a coil of intestine may be compressed, giving rise to symptoms of ileus, or the same symptoms may result from the twisting of the pedicle of the spleen.

Diagnosis.—The diagnosis of floating spleen is determined by the absence of the organ from its natural position. This may be determined by percussion. If the organ be absent, a tympanic sound will be elicited from the left flexure of the colon, which has taken the place of the absent organ. To make it more positive, the colon should be filled with water, when dullness will be elicited, and, after allowing the water to run off, the tympanic sound returns.

Where the abdominal walls are thin and the spleen hypertrophied, the organ may be outlined in the left iliac region. The diagnosis, however, is difficult and many times is not made during life.

Prognosis.—As to cure unfavorable, though the life may be but little endangered. Should twisting of the pedicle occur, strangulation and necrosis may occur, resulting in death.

Treatment.—Where possible, the spleen is to be returned to its proper place, and a pad and bandage used, though it is extremely difficult to retain the organ in place by tills method, and splenopexy may have to be resorted to in order to securely anchor it.

Where the dislocation has been due to malarial engorgement or hypertrophy, the after treatment will consist in relieving the congestion. For this purpose polymnia uvedalia will be used internally and locally. Of the specific tincture, one or two drams will be added to four ounces of water, and a teaspoonful given every three or four hours. As a local application we will use the uvedalia ointment, thoroughly rubbing it over the enlarged organ, and, with a flannel cloth spread over it, pass a smoothing iron over it as hot as can be borne.

Where splenopexy-fixation is a failure, splenectomy may be tried as a last resort. Of forty cases of splenectomy recorded by Vulpius, thirteen died, giving a mortality of thirty-two and a half per cent.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.