Portal speaks of a rupture of the spleen
simply from engorgement. There was no history of a fall,
contusion, or other injury. Tait describes a case of rupture of
the spleen in a woman who, in attempting to avoid her husband's
kick, fell on the edge of the table. There were no signs of
external violence, but she died the third day afterward. The
abdomen was found full of blood, and the spleen and peritoneal
covering was ruptured for three inches.
Splenectomy, excision of the spleen, has been performed a number
of times, with varying results, but is more successful when
performed for injury than when for disease. Ashhurst has
tabulated a total of 109 operations, 27 having been for traumatic
causes, and all but five having terminated successfully; of 82
operations for disease, only 32 recovered. Vulpius has collected
117 cases of splenectomy, with a death-rate of 50 per cent. If,
however, from these cases we deduct those suffering with
leukocythemia and lardaceous spleen, in which the operation
should not be performed, the mortality in the remaining 85 cases
is reduced to 33 per cent. Terrier speaks of splenectomy for
torsion or twisting of the pedicle, and such is mentioned by Sir
Astley Cooper, who has found records of only four such cases.
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