Accidental injection of oily contrast into the splenoportal system in a case of tuberculosis of the spleen.

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The clinical value of fistulography and sinography is well documented (Gage and Williams, 1943; Pendergrass and Ward, 1947; Dell, 1949; Goldfarb, Monafo and McAlister, 1964). It is common practice to introduce the contrast material under fluoroscopy. Where the fistulous openings are such that even the best instruments fail to prevent regurgitation of the contrast during injection, the “overcouch” method is a satisfactory alternative. Saxton and Strickland (1964) advocate its use particularly in the investigation of sinuses which are suspected to originate from bone infection, a situation in which films with sharp definition are required. An inherent drawback of this technique is the inability to make full use of fluoroscopic control during contrast injection. A rare case of primary splenic tuberculosis is presented here to record an unusual complication which might have been avoided if fluoroscopy had been used. S.Y.P., a male Chinese patient aged 63 years, presented in June, 1968 with a chronic discharging sinus in the left hypochondrium of ten months’ duration. He had been a known diabetic for the past ten years and between 1963 and 1965 was treated for pulmonary tuberculosis. Towards the middle of 1967 he developed a tender, hard, left hypochondrial swelling. This was incised and drained, but the wound did not heal. During the same period a similar swelling appeared in his left loin. It was drained and the wound healed spontaneously.