Banti's disease with gastrorrhagias and thrombophlebitis

Abstract

T HE frequent preand postoperative hemorrhages from the gastrointestina track in spIenic anemia present a serious probIem in the treatment of Banti’s spIenomegaIy. SeveraI recent case reports, l--j especiaIIy that of Pemberton’s,6 demonstrate the gravity of this gastrorrhagic tendency. The amount of bIood Iost varies from a few drams to one quart or more at each bIeeding. The onset of hemorrhages occurs without any prodroma1 signs and takes pIace in the second and third stage of Banti’s disease. The youngest patient with gastrorrhagia was eighteen year? and the oIdest fifty-eight years. 3 symptomatoIogy, depending on whether it affects different organs in succession or simuItaneousIy. Epinger and BrandeIberg” deny a distinct entity to Banti’s disease, arguing that histopathoIogy of spIenic anemia is aImost identica1 with lesions found in certain cases of cirrhosis of the Iiver, tubercuIosis, maIaria and syphiIis. There are no positive diagnostic criteria from either a clinica or a Iaboratory point of view. The cytoIogy of Banti’s disease indicates onIy a secondary anemia with diminished red bIood ceI1 count and hemoglobin in proportion, and with the white bIood count aIso diminished CorrespondingIy. The causative factors may be divided into two groups: (I) mechanica and (2) physiopathoIogica1. The enIargement of the spIeen, by its size and weight, may compress and distort the IineaI vein, thus impeding its circuIation. Such a compression may aIso estabIish secondary traumatic changes in the waI1 of bIood vessels leading to aseptic thrombophIebitis of the spIenoporta1 veins. That the size of the spIeen, per se, is not a sufficient factor in obstructing the venous fIow from the spIeen is demonstrated by spIenomegaIies of other diseases without gastric hemorrhages such as Gaucher’s.* These cases with marked Ieucopenia and increased urobiIin and urobiIinogen, indicating progressive destruction of bIood eIements, have a bad prognosis after spIenectomy.12 SimiIarIy after marked gastrorrhagias with depressed bone marrow response, as indicated by the absence of nucIeated red bIood ceIIs in the circuIation, spIenectomy is futiIe.5 The onIy favorabIe sign is increase of choIestero1, such a case being reported by Hanrahan12 twenty-five years after spIenectomy.