Spleen.—After a simple contusion the spleen soon returns to its normal condi tion without further trouble, and a few days in bed, coupled with strapping of the side to limit motion, usually suffice. When, however, there is laceration of the parenchyma the convalescence is slow, abscesses following in quick succession. After a time these cease and recovery is uninterrupted. Symptomatic treatment, revulsion over the organ, and tonics may shorten the duration of such eases.
When the symptoms do indicate that exsanguination of the patient is taking place, death will most probably follow, although the hemorrhage is not as copi ous as it can be in tears of the liver, the splenic capsule being more elastic than that of the latter organ. Removal of the organ should be resorted to. The ab dominal wall is opened by means of an incision through the left semilunar line and the peritoneum is freely opened.
The hand being introduced into the cavity, all adhesions are torn up and the organ. is brought to view. The vessels entering the hilum are then clamped and the organ is removed. The stump is ligated and, after sponging out the abdominal cavity, the wound is closed.
Results of splenectomy for rupture. Study of seven cases suggests following conclusions: 1. A marked leucocytosis follows removal of the spleen. It follows immediately after removal, and continues gradually to decline; lasts six months or more. 2. The various forms of leucocytes are increased in number in various pro portions, and do not bear the same ratio to each other as in normal blood. 3. The anamnia produced by the accident is very slowly recovered from after the re moval of the spleen. 4. In a certain number of cases (three out of seven) the removal of the organ is followed at an interval of from ten days to three weeks by a train of symptoms characterized by pyrexia, wasting, extreme weakness, an Eemia, frequent pulse, pallor, thirst, and headache, which last for a varying period and are slowly recovered from. 5. The external lymphatic glands undergo en largement and in some cases a marked hypertrophy. George Heaton (Brit. Med. Jour., Aug. 19, '99).
Eidney.—The majority of mild cases of perirenal extravasations of blood and urine recover as the result of rest and expectant treatment. The patient
should be kept in bed and his diet limited to liquids, the best of which is milk; this beverage requires, besides. the least physiological labor from the in jured organ. The nourishment of the patient may further be sustained by rectal injections of beef-tea, and these should entirely be resorted to if there is vomiting, the latter tending greatly to encourage haemorrhage. When the latter occurs in the direction of the bladder, there is likely to be accumulation of blood-clots, which, if small, will readily pass out with the urine. Frequently, however, the clots are large and cause retention of urine and marked tenesmus. A large catheter should therefore be in troduced and kept in situ when the hcematuria is marked, and the bladder occasionally washed out with a weak boric-acid solution. Median urethrot omy to remove clots and relieve reten tion sometimes becomes necessary in these cases. When the symptoms do not improve under these measures, an incis ion should be made, exposing the seat of injury, the extravasation removed, and the parts restored, by appropriate meas ures, to their normal conformation.
There is great danger in delaying operation in these eases; the decompo sition of the clots and the cystitis which is excited by their presence, as well as the frequent catheterization needed, ex pose the patient to all the dangers of suppuration of the wounded kidney, and also to the risk of infection. Henry Morris (Clin. Jour., Aug. 1, '94).
The dangers of rupture of the kidney are mainly hxmorrhage and sepsis. When, therefore, the symptoms are such as to indicate marked hemorrhage or sepsis, and especially if a tumor form quickly in the lumbar region, an explora tory operation should at once be done. If severe laceration be present, or the kidney's functions be practically coin promised, or the haemorrhage be such as to require ligation of the renal vessels, lumbar nephrectomy should immedi ately be performed, primary nephrec tomy being safer than secondary re moval of the organ.
Eleven cases of kidney traumatisms, with eight recoveries and three deaths, expectant treatment having been em ployed. Wagner (Deutsche Zeit. f. Chin, B. 34, p. OS, '93).