Chronic malarial spleen tends to be dark grey, with increased density of connective tissue and fibrosis, resulting in a heavy, often massively enlarged organ with a firm or hard capsule. In addition, disruption of the spleen capsule and single or multiple tears in the underlying parenchyma may be found. In both of the cases described above, the spleen was massively enlarged. Microscopic examination demonstrated haemozoin, parasitized and uninfected erythrocytes, and a massive proliferation of macrophages throughout the capillaries, venous sinuses and pulp spaces. There is congestion and dilatation of sinuses and scattered thrombosis, with focal necrosis in capillaries and splenic pulp.
Splenectomy is accepted as the treatment of choice in cases of spontaneous rupture of the spleen.
In areas in which malaria is endemic, there is growing evidence to suggest that management of spontaneous rupture of malarial spleen without splenectomy should be attempted. A conservative strategy is also reasonable in patients who travel frequently to malarious areas. Primary exposure to malaria and infection with P vivax appear to be important factors in spontaneous rupture of the spleen. Malaria is still important in the southeast Anatolia region of Turkey. United States, weeks ending December 29.