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Surgical Diseases of the Spleen


The spleen is the largest organ of the reticuloendothelial system, responsible for many filtration and host defense mechanisms; however, it is not well understood. It plays a role in many childhood and adulthood hematologic and immunologic disorders and can cause significant morbidity and mortality in blunt and penetrating trauma. Previous management included simple and straightforward guidelines for splenectomy; the indications for surgical management of splenic disease have drastically changed, with more conservative treatment dominating.

I

Anatomy

A

Average Adult Spleen

  • 1.

    Weight: 150 g; length: 7–11 cm

B

Encapsulated

  • 1.

    Capsule approximately 1–2 mm in thickness

C

Splenomegaly Definition

  • 1.

    Weight: greater than 500 g; length: greater than 15 cm

D

Blood Supply

  • 1.

    Arterial

    • a.

      Splenic artery off of the celiac trunk

    • b.

      Short gastric arteries

    • c.

      Branch from left gastroepiploic artery, contained in gastrosplenic ligament

  • 2.

    Venous drainage

    • a.

      Splenic vein, which is posterior and inferior to splenic artery and joins superior mesenteric vein to form the portal vein

E

Structural Support

  • 1.

    Suspended via four ligaments

  • 2.

    Splenocolic, gastrosplenic, phrenosplenic, and splenorenal ligaments

F

Microanatomy

  • 1.

    Red pulp

    • a.

      Comprises 75% of splenic volume

    • b.

      Venous sinuses surrounded by reticulum

    • c.

      Site of splenic macrophages responsible for filtration system

  • 2.

    Marginal zone—narrow interface between red and white pulp

  • 3.

    White pulp

    • a.

      Comprises 25% of splenic volume

    • b.

      Consists of lymphoid follicles

G

Accessory Spleens

  • 1.

    Present in 20% of the population

  • 2.

    Most common locations

    • a.

      Approximately 80% in splenic hilum/vascular pedicle

    • b.

      Remainder dispersed in gastrocolic ligament, pancreatic tail, greater omentum, greater curve of the stomach, and mesentery

II

Function

A

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