Tropical splenomegaly: surgical aspects.

At the University College Hospital, Ibadan, Nigeria, in a 22-month period from January 1975 to September 1976, nine splenectomies were electively performed for unruptured spleens. The diagnoses were either tropical splenomegaly syndrome (when no obvious cause was found to be responsible for, or associated with, the splenomegaly) or splenic abscess in various stages of formation. The weights of the spleens removed ranged from 160 g in a 15-year-old girl to 5080 g in a 39-year-old male. One death due to uncontrollable bleeding from the splenic bed occurred. Histology of the spleens after removal showed lymphosarcoma in one, non-specific changes in another, and thickened fibrous capsule, perisplenitis, haemorrhagic infarcts, pockets of chocolate-coloured fluid and inflammatory processes in various stages in the other seven. In the tropics, enlarged spleens with no obvious cause or associated condition are often best treated by splenectomy for histological diagnosis, definitive treatment and the prevention of rupture caused by minor trauma. There are, as yet, no convincing data which show that splenectomy in the tropics causes a significant diminution of immunity to malaria (or other diseases) and it does not, therefore, predispose to the development of cerebral malaria.