406 THE DUCTLESS GLANDS 



splenic vein receives tributaries from the stomach and the pan- 

 creas, and, near its termination, it is joined by the inferior 

 mesenteric vein. Finally, it unites with the superior mesenteric 

 vein to form the vena portse. In portal obstruction, the 

 splenic vein shares in the obstruction, and the resulting venous 

 congestion of the spleen causes definite enlargement of that 

 organ (p. 274). 



In addition to pouring its blood into the portal circulation, 

 the spleen undergoes slow, rhythmic contractions, which 

 greatly assist the flow of blood through the portal system. 

 These contractions occur once per minute and they dis- 

 appear altogether when the spleen becomes enlarged. Very 

 little is known with regard to the mechanism by which the 

 contractions are controlled, but, when the organ becomes in- 

 creased in size, the contractions either diminish or disappear 

 entirely, so that they are of little help from the point of view 

 of diagnosis. 



Movable spleen, though uncommon, is a well-recognised 

 condition. It usually occurs in association with complete 

 visceroptosis (cf. p. 389), and is due to the increased extent and 

 laxity of its peritoneal connexions, namely, the gastro-splenic 

 and the lieno-renal ligaments. The condition, per se, is of 

 little or no importance, but it may be accompanied by pain 

 due to stretching of the peritoneum (cf. movable kidney, p. 360). 

 It sometimes happens that the lieno-renal ligament becomes 

 twisted and this produces kinking of the contained splenic vein. 

 As a result, the organ becomes greatly distended and the con- 

 dition is apt to be mistaken for an ovarian cyst with a twisted 

 pedicle. The mistake, however, is of little consequence, since 

 both conditions call for immediate surgical interference. 



The operation of complete splenectomy has been carried out 

 for movable spleen and after rupture of the viscus, and it 

 is not followed by any grave disturbance in the general 

 state of health. 



Puncture of the Spleen. When it is desired to obtain a 

 specimen of the blood in the interior of the spleen, a hypo- 



