Perisplenitis

PERISPLENITIS, inflammation of the capsule of the spleen, has no independent significance, as it depends on corresponding changes in either the spleen, the peritoneum, the left pleural cavity, or adjacent organs (left kidney, colon, stomach, left lung), or it represents a partial manifestation of polyserositis (e.g., it often accompanies the formation of 'sugar-coated' liver). The dependence of perisplenitis on changes in the spleen is conditioned by the close connection between the capsule and its trabeculae and the almost uniform structure of both. In such a case, the inflammatory process spreads to the capsule of the spleen from foci of changes lying in the depths and reaching the capsule. Thus, perisplenitis of various kinds (fibrinous, purulent, and putrid) can be observed in infarcts, echinococcosis, and abscess of the spleen. In addition, acute perisplenitis often occurs in banal septic hyperplasias of the spleen. Both the exudate and its consequences in the form of adhesions are localized with special preference according to the furrows and notches of the edges of the spleen, as the causative agents of inflammation are retained here. More often than fresh inflammatory changes, one encounters their remnants in the form of thickening or adhesions of the splenic capsule (adhesive perisplenitis). Sometimes fresh adhesions break off, and then a picture of so-called villous or hairy perisplenitis arises, analogous to what is observed in fibrinous pericarditis. Thickenings can have the appearance of separate dense plaques, nodules, or nodes of a whitish or brownish color, and then one speaks of chronic nodular perisplenitis. Sometimes a picture of chronic hyperplastic perisplenitis is obtained (syn.: sugar-coated spleen, perisplenitis chronica cartilaginea) (see Sugar-coated organs). In this latter case, there is a sharp difference from ordinary chronic perisplenitis, as inflammatory changes in the thickenings of the capsule in a sugar-coated spleen may be absent (see Perihepatitis). Besides these, perisplenitis of specific origin is also observed (in tuberculosis, in syphilis). In tuberculosis of the peritoneum, perisplenitis in the form of large nodes and miliary tubercles of the splenic capsule can be encountered even without changes in the spleen itself. Perisplenitis in congenital syphilis is a very frequent phenomenon: according to Lubarsch, in half of all cases of changes in the spleen in syphilis, or even more often, there is perisplenitis; the process usually has the character of typical fibrinous perisplenitis, and numerous pale spirochetes are found in smears from the fibrinous coating. In the beginning, any proliferation of connective tissue is absent, and only in later stages do focal or diffuse whitish-gray thickenings of the splenic capsule occur, eventually turning into sugar-coated thickenings. Sometimes fibrinous perisplenitis in syphilis is a partial manifestation of general fibrinous inflammation of the peritoneum. In the thickenings of the splenic capsule, gummatous changes can also be encountered, which are often characterized by an unusual proliferation of reticular cells, sometimes taking on the appearance of Gaucher cells.