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CONGENITAL ABNORMALITIES OF THE SPLEEN Splenic agenesis is rare but is present in 5% of children with congenital heart disease. Polysplenia is a rare condition result ing from failure of splenic fusion. Splenunculi are single or multiple accessory spleens th...

EMBRYOLOGY, ANATOMY AND PHYSIOLOGY Embryology Fetal splenic tissue develops from condensations of mesoderm in the dorsal mesogastrium. This peritoneal fold attaches the dorsal body wall to the fusiform swelling in the foregut that develops into the stomach. T...

FUNCTIONS OF THE SPLEEN Although the spleen was previously thought to be dispensable, it is now recognised that an incidental splenectomy during the course of another operative procedure increases the risk of complications and death. The surgeon should there...

FURTHER READING e Boyle S, White RH, Brunson A, Wun T . Splenectomy and the inci - dence of venous thromboembolism and sepsis in patients with im - mune thrombocytopenia. Blood 2013; 121 : 4782–90. Di Sabatino A, Carsetti R, Corazza GR. Post splenectomy and ...

Felty’s syndrome Patients with rheumatoid arthritis may develop leukopenia. This is referred to as Felty’s syndrome if it is extreme and associated with splenomegaly . Splenectomy produces only a transient improvement in the blood picture, but rheumatoid arth...

Gaucher’s disease This lipid storage disease is characterised by storage of glucocerebroside in the reticuloendothelial system and in the spleen. Enormous splenic enlargement may be associated with yellowish brown discoloration of the skin on the hands - and...

Haemolytic anaemias There are four causes of haemolytic anaemia that are generally amenable to splenectomy . Hereditary spherocytosis is an autosomal dominant hereditary disorder characterised by the presence of spherocytic red cells, caused by various molec...

Hypersplenism due to portal hypertension Splenomegaly is an invariable feature of portal hypertension ( Figure 70.13 ) and results in the thrombocytopenia and granu - locytopenia observed in these patients. These may be improved if the portal hypertension is...

Idiopathic thrombocytopenic purpura ITP , also known as immune and autoimmune thrombocy - topenic purpura, results from antibodies to specific platelet membrane glycoproteins (antiplatelet IgG autoantibodies) that result in isolated thrombocytopenia in the pres...

Introduction No content extracted automatically.

Learning objectives To understand: The function of the spleen • The common pathologies involving the spleen • The principles and potential complications of splenectomy • The potential advantages of laparoscopic splenectomy •

Leukaemia Leukaemia should be considered in the di ff erential diagnosis of splenomegaly . The diagnosis is made by examining a blood or bone marrow film. Splenectomy is reserved for hypersplenism that occurs during the chronic phase of chronic granulocytic leu...

NEOPLASMS Haemangioma is the most common benign tumour of the spleen. It may rarely develop into a haemangiosarcoma. The spleen is rarely the site of metastatic disease. Lymphoma is the most common cause of neoplastic enlargement and splenec tomy may play a...

Physiology The splenic parenchyma consists of white and red pulp that is surrounded by serosa and a collagenous capsule with smooth muscle fibres. These penetrate the parenchyma as trabeculae of dense connective tissue fibres rich in collagen and elastic tissue...

Porphyria Porphyria is a hereditary error of haemoglobin catabolism in - which porphyrinuria occurs. The urine may be orange and develops a port-wine colour after a few hours of exposure to the air. Splenectomy has little role to play in the management.

Postoperative complications Immediate complications specific to splenectomy include haemorrhage resulting from a slipped ligature. Left basal Figure 70.16 Photograph showing a stapling device across the splenic hilus for division of the splenic vessels during...

Radiological imaging Plain radiology is rarely used in investigation, but the inciden tal finding of calcification of the splenic artery or spleen may raise the possible diagnosis of a splenic artery aneurysm, an old infarct, a benign cyst or hydatid disease ....

Rupture of a malarial spleen In tropical countries, rupture of a spleen enlarged as a result of malaria is not uncommon (see Tropical splenomegaly Delayed presentation following a ‘trivial’ injury is not infre quent. In such patients, radiological embolisatio...