Splenectomy in tropical splenomegaly.

"Big Spleen Disease"-Hamilton et al. MEBRITCLSH 825 44%. His only treatment has been a 15-day course of primaquine followed by 100 mg. of proguanil daily. This is further evidence for a malarial cause of this syndrome and also for implicating the spleen in the plasma volume changes. The role of the spleen is also shown by a case of Felty's syndrome (Pengelly, 1966), in which a marked reduction in spleen size and plasma volume after corticosteroid therapy was found. Not all patients with big spleen disease or idiopathic tropical splenomegaly respond to antimalarial therapy, and even for those cases which do respond long-term supervision may be impossible. In those patients with chronic abdominal pain, an enormous spleen, and gross dilution anaemia, splen-ectomy may be the treatment of choice. M. Paliwoda (personal communication, 1967) carried out 70 splenectomies for cases such as these in Uganda with an operative mortality of only 4.3 %, and though the follow-up data are incomplete the patients in general seem to have done well. However, the spleens are large, and good surgical technique with wide exposure is necessary. There is a danger of overtransfusing a hypervolaemic patient and also the added risk in the tropics of patients being particularly prone to infection after splenectomy. Fatalities from P. falciparum after splenectomy have occurred in West Africa (Watson-Williams, personal communication). In this series, postoperatively, the patients all registered high antibody levels to malaria and two developed a high brucella antibody titre; however, none seem to have suffered from significant clinical malaria. Against these dangers must be set the marked improvement in the well-being of these patients, who were able to return to doing a normal day's work after splenectomy. Summary The clinical and haematological effects of splenectomy on five Ugandan patients with "big spleen disease" were studied 15 months after operation and the results compared with those obtained preoperatively. All patients were symptomatically much improved and they all showed a marked improvement in their haemoglobin and P.C.V. levels. Before operation the patients had marked hyper-volaemia and dilution anaemia, but after splenectomy the plasma volumes had returned to normal in three patients and in two were still slightly raised. One patient had developed evidence of myelofibrosis, but the others showed no marked change in liver biopsy appearances. There were no untoward effects of splenectomy and no acute attack of malaria was described, though the malaria antibody titre had been …