WANDERING SPLEEN. 755 



then be readily replaced if the body is favorably placed. In higher 

 grades it usually lies in the left, sometimes in the right iliac region, 

 with the hilus upward, held by a string consisting of the gastro- 

 splenic ligament and the vessels of the pancreas and spleen. The 

 spleen is usually twisted several times on its horizontal axis, as is 

 shown by the string. The twisting probably begins by the spleen 

 being thrown forward by the spleno-phrenic ligament. The dislo- 

 cated spleen is often attached in its new position by pseudo-mem- 

 branous adhesions. It may also undergo changes and atrophy from 

 pressure and twisting of its vessels. The dislocation may last long 

 and even be permanent, but in other cases it may sooner or later 

 cause death by gangrene from obstruction of the vessels of the 

 stomach. This is hastened by distention of the stomach from pres- 

 sure on the duodenum by the pancreas and the cord going to the 

 hilus of the spleen. Diagnosis of movable spleen is easy ; for, al- 

 though absence of splenic dulness does not prove displacement of 

 the organ, the coincidence of a tumor in the abdomen which has 

 the size and shape of the spleen removes all doubt. 



Treatment can only aim at preventing stretching of the pedicle 

 by a suitable abdominal bandage, and relieving any existing disease 

 of the spleen.] 



