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SPLENECTOMY The common indications for splenectomy are: - /uni25CF trauma resulting from an accident or iatrogenic during a surgical procedure; for example, during mobilisation of the oesophagus, stomach, distal pancreas or splenic flexure of the colon; /uni25...

SPLENIC ARTERY ANEURYSM, INFARCT AND RUPTURE Splenic artery aneurysm Aneurysms involving the splenic artery are estimated to be identified at 0.04–1% of postmortem examinations. They are twice as common in women and are usually situated in the main arterial tr...

SPLENOMEGAL Y AND HYPERSPLENISM Splenomegaly is a common feature of many disease processes, although the spleen has to enlarge threefold before it is palpable ( Table 70.2 ). It should be borne in mind that many conditions a ff ecting the spleen, such as idiopa...

Schistosomiasis This condition is prevalent in Africa, Asia and South America. It is caused by infection with Schistosoma mansoni in 75% of cases and by Schistosoma haematobium in the remainder. Splenic enlargement may result from portal hypertension associate...

Splenic abscess Splenic abscess may arise from an infected splenic embolus or in association with typhoid and paratyphoid fever, osteomyelitis, ). otitis media and puerperal sepsis. In general surgical practice, - it may be associated with pancreatic necrosis ...

Splenic infarction This condition commonly occurs in patients with a massively enlarged spleen from myeloproliferative syndrome, portal hypertension or vascular occlusion produced by previous surgical intervention (such as spleen-preserving distal pancre - ate...

Splenic rupture due to trauma The spleen is the most commonly injured intra-abdominal organ followed by the liver. Splenic rupture should be consid - ered in any case of blunt abdominal trauma, particularly when the injury occurs to the left upper quadrant of...

Technique of laparoscopic

Technique of open splenectomy Most surgeons use a midline or transverse left subcostal incision for open splenectomy with the patient in the supine position. Rarely , a thoracoabdominal incision may be necessary for a massive spleen that is adherent to the dia...

Tropical splenomegaly Massive splenic enlargement frequently occurs in the tropics from malaria, kala-azar and schistosomiasis. Occasionally , splenomegaly cannot be fully attributed to these diseases and may result from occult infection or be related to malnu...

Tuberculosis The diagnosis of tuberculosis should be considered in young adults with splenomegaly presenting with asthenia, loss of weight and fever. Tuberculosis of the spleen may produce portal hypertension or, rarely , cold abscess. CT shows small low-atte...

Absence of the cystic duct This ‘anomaly’ is usually pathological, indicating the recent passage of a stone or, in the presence of jaundice, a stone at the lower end of the cystic duct ulcerating into the CBD (Mirizzi syndrome). The main danger at surgery i...

Absence of the gallbladder Rarely , the gallbladder is absent; failure to visualise it should not be mistaken for pathology . H Joachim Burhenne , 1925–1996, radiologist, Vancouver, Canada, described this technique in 1973. (a) (b) (c) (d) - 1 2 1 2 1 1 2 Figu...

Accessory cholecystohepatic duct Ducts passing directly into the gallbladder from the liver are not uncommon. Larger ducts should be closed, but before doing so the precise anatomy should be carefully ascertained to ensure that the right hepatic duct is not be...

BILIARY TRACT Biliary ascariasis The roundworm Ascaris lumbricoides commonly infests the intestines of inhabitants in Asia, Africa and Central America. It may enter the biliary tree through the ampulla of Vater and cause biliary pain. Complications include o...

Bile duct injuries About 15% of injuries to the bile ducts are recognised at the time of operation; in the remainder, the injury declares itself postoperatively either by profuse and persistent leakage of bile (if drainage has been provided; bile peritonit...

Blood supply to the bile ducts The supraduodenal CBD is supplied by the left and right choledochal arteries, arising from the posterior superior pancreaticoduodenal artery below and the right (RHA) and left (LHA) hepatic arteries and cystic arteries above ( Fi...

CHOLECYSTECTOMY Preparation for operation After appropriate history taking and assessment of the patient’s fitness for the procedure, routine laboratory investigations including a coagulation screen and liver function tests should tive be checked. The patient...