Anatomy

Anatomy

The weight of the normal adult spleen is 75–250 /uni00A0 g and it measures up to 10 /uni00A0×/uni00A0 7 /uni00A0×/uni00A0 3 /uni00A0 cm. It lies in the left hypochondrium between the gastric fundus and the left hemidiaphragm, with its long axis lying along the 10th rib. The spleen is connected to the stomach and kidney by a double fold of peritoneum that originates from the stomach as a part of the greater omentum. The gastrosplenic (gastrolienal) ligament is anterior to the splenic hilum and connects the spleen to the greater curvature of the stomach. The splenorenal (lienorenal) ligament lies posterior to the splenic hilum and connects the hilum of the spleen to the left kidney . The splenic vessels and the tail of the pancreas lie within this ligament ( Figure 70.1 ). The hilum of the spleen sits in the angle between the stomach and the kidney and is in contact with the tail of the pancreas. The concave visceral surface lies in contact with these structures, and the lower pole extends no further than the midaxillary line. There is a notch on the inferolateral border, and this may be palpated only when the spleen is enlarged. The tortuous splenic artery arises from the coeliac axis and runs along the upper border of the body and tail of the pancreas, to which it gives small branches. The short gastric and left gastroepiploic branches pass between the layers of the gastrosplenic ligament. These arteries are divided whenever the greater curvature of the stomach has to be excised. The main splenic artery generally divides into superior and inferior branches, which, in turn, subdivide into several segmental branches. The splenic vein is formed from several tributaries that drain the hilum and runs behind the pancreas, receiving several small tributaries from the pancreas before joining the superior mesenteric vein at the neck of the pancreas to form the portal vein ( Figure 70.2 ). The splenic pulp is invested by an external serous and inter - nal fibroelastic coat, which is reflected inwards at the hilum onto the vessels to form vascular sheaths. The lymphatic drain - age comprises e ff erent vessels in the white pulp that run with the arterioles and emerge from nodes at the hilum. These nodes and lymphatics drain via retropancreatic nodes to the coeliac nodes .

The bene /f_i ts of splenic conservation • The importance of prophylaxis against infection following • splenectomy