Diseases of Spleen

1. NUR FADZLINA ZABRI
082013100006

2. Embryology
 Condensations of mesogastrium in dorsal
mesogastrium

4. Anatomy

6. Functions of spleen
• Immune function – major site of IgM
production and opsonins
• Filter function – cellular and non cellular
• Reservoir function – contains 8% of red cell
mass
• Hematopoesis – in fetal life and hematological
disorder

7. Investigations
• History – pain, infection, hemolytic disease in
family
• Examination findings – splenomegaly, splenic
bruit
• Laboratory examination – full blood count,
reticulocyte count, hemolytic test
• Radiological imaging – plain radiology, US,CT,
MRI

8. DISEASES OF SPLEEN
A) Spleen anomalies
i. Splenic agenesis
ii. Polysplenia – results from failure of splenic fusion
iii. Splenunculi – single/multiple spleen accessory
iv. Hamartomas
v. Non parasitic splenic cyst

9. B) Splenic artery aneurysm, infarct and rupture
Splenic artery rupture
• Associated with atherosclerotic patient
• Consequence of intraabdominal sepsis or
pancreatic necrosis
• Presence of splenic bruit
•Detected on Xray or scan
•Treatment – splenectomy and removal of diseased
artery

10. Splenic infarction
Massive splenomegaly :
• Myeloproliferative
syndrome
• Portal hypertension
• Splenic vein
thrombosis
• Sickle cell disease
- Left shoulder tip
pain
- Infarct causing
abscess requires
splenectomy

11. Splenic rupture
Causes ;
- Blunt abdominal
trauma
- Iatrogenic injury
Rupture of malarial
spleen
- Rupture of enlarged
spleen due to
malaria
- Must undergo
splenectomy before
perisplenic
hematoma ruptures

12. C) Splenomegaly and hypersplenism

14. Splenic abscess
– Rare- should be suspected
when there is progressive
splenic enlargement with
bacteremia and abscess
formation at other sites
– Associated with
– Pancreatic necrosis
– Intra abdominal infection
– Care : percutaneus drainage
of the splenic abscess under
radiological guidance

15. Tuberculosis of spleen
– Young adults with splenomegaly : asthenia, loss of weight,
fever
– Anti tuberculous drug
– Splenectomy is difficult

16. Tropical splenomegaly
– Occurs in tropical country
– Malaria
– Kalazar
– Schistosomiasis
– Occult infection
– Malnutrition
– Requires splenectomy
Results from portal
hypertension associated with
Hepatic fibrosis
or
Hyperplasia of induced
phagocytosis of disintegrated
worms, ova or toxin

17. Idiopathic thrombocytopenic purpura
– Antibodies develop against platelet membrane
glycoprotein that damages patient’s platelet
– Features
– Purpuric patches on skin and mucosa
(ecchymoses)
– Numbers of petechial hemorrhages
– Tendency of spontaneous bleeding
– Corticosteroids
– Steroid relapses or platelet remains low 
splenectomy

18. Hemolytic anemia
Hereditary spherocytosis
• AD hereditary disorder
• Presence of spherocytic red cells, various in
molecular defects in the gene
• Mild jaundice, anemia, splenomegaly and
gallstones
• Splenectomy done after 6 years of age

19. Thalassemia
• Defects in the hemoglobin
peptide chain synthesis
• Chronic anemia, jaundice,
splenomegaly, hemolytic
facies
• Requires blood transfusion
• Splenectomy ;
• Transfusion dependent
• Hemolytic antibodies develop

20. Sickle cell anemia
• Hb A is being replaced by Hb S
• Hb S crystallises when oxygen tension is
reduce  distorting elongated red cell
• Increase blood viscosity
• Obstruct the flow of blood in spleen
Crisis – adequate hydration, partial exchange transfusion
Splenectomy in splenic sequestration aggravates anemia

21. Porphyria
– Hereditary error of hemoglobin catabolism
– Features :
• Abdominal crises – intestinal colic, constipation
• Anemic
• Photosensitivity
• Splenomegaly
• Port-wine colour urine
– Splenectomy has little role in management

22. Gauchers disease
– Defect of glycosphingolipid metabolism- accumulation
of glucocerebroside
– Enormous splenic enlargement + yellowish brown
discoloration of skin, anemia, conjunctival thickening

23. Hypersplenism due to portal hypertension
– Results in thrombytopenia and granulocytopenia
– Care : shunt surgery or liver transplantation
– Symptomatic esophagogastric varices requires
splenectomy

24. Felty’s syndrome
Treated with steroids or splenectomy

25. • Common benign tumor of spleen
• Rarely develop into hemangiosarcoma
• Treatment – splenectomy
D) Neoplasm
Hemangioma

26. Lymphoma
• Common cause of neoplastic enlargement
• Splenectomy is required for achieving the
diagnosis in the absence of palpable lymph
node or
• Relieving gross splenomegaly

27. • Results from abnormal proliferation of
mesenchymal elements in the bone marrow,
spleen, liver, lymph node
• Pain due to gross enlargement or splenic
infarction
• Splenectomy
Myelofibrosis

28. INDICATIONS
• Trauma
• Oncological – part en bloc resection,
therapeutic, diagnostic
• To reduce anemia or thrombocytopenia in
spherocytosis, ITP, hypersplenism
• Variceal surgery for portal hypertension
SPLENECTOMY

29. Preoperative preparation
Coagulation profile
– Should be near normal
– Bleeding tendency – blood transfucion, FFP,
cryoprecipitate, platelets
Antibiotic prophylaxis
– To prevent post-splenectomy sepsis

30. Technique of open splenectomy
Midline or transverse left subcostal
incision or thoracoabdominal incision
Gastrosplenic ligament is open up,
short gastric vessels are divided
Splenic vessels are suture-ligated

31. Posterior surface of spleen is ligated
Lienorenal ligament is divided with
long curved scissors
Spleen is rotated medially along with
the tail and body of the pancreas
Pancreas is separated from the hilar
vessels, ligated and divided

32. Hemostasis
• Ligation or application of metal clips to
intrasplenic vessels
• Application of hemostatic agents or mesh

33. A long incision is
made from the
xiphoid process
down to just
below umbilicus
Splenic blood
vessels are
ligated and the
spleen is
dissected out
The vessels are
tied off and the
packing is
removed
Packing is
placed in the
abdomen to
stop the
bleeding.
Blunt
dissection is
then used to
locate the
source od
hemorrhage

34. Technique of laparoscopic splenectomy

35. Spleen is separated from the
kidney and diaphragm
Pulled the liver aside
Pull back the stomach to reveal
the spleen
Spleen tissue are then cut.

36. Self retaining opening bag
is introduced and spleen is
broken into smaller pieces
Splenic artery and vein are
closed off and cut

38. • Hemorrhage dt slipped ligature
• Hematemesis dt gastric mucosal damage
• Left basal atelectasis, Pleural effusion
• Fistula from damage of the greater curvature of
stomach
• Pancreatitis , localised abscess
• Postoperative thrombocytosis
• Post splenectomy septicemia
• Opportunist post-splenectomy infection
Post operative complication

39. Opportunist post-splenectomy infection
(OPSI)
Recommendations
– Immunisation
– Antibiotic prophylaxis
– Education : travel advise
– Prompt treatment of infection

40. Antibiotic prophylaxis
– Oral penicillin,erythromycin, amoxicillin, co-
amoxiclav
– <5 years age : daily dose of penicillin for 10 years
– Older children : prophylaxis is continued till 16
years of age
Immunization
– Vaccination against pneumococcus,
meningococcus C, H. influenzae type B
– Given 2 weeks before elective surgery or as soon
as possible as recovery from surgery
Allergy to penicillin– cefotaxime,
ceftriaxone, chloramphenicol

41. Education
– Should carry medical alert and Up to date
vaccination card
– Give specific advice on
– travel : use all physical anti-mosquito
barriers, anti-malarial therapy
– animal handling : Capnocytophaga
canimorsus

42. REFERENCES
• Bailey and Love
• https://www.youtube.com/watch?v=gC0aaE7J
W2Y
• http://preop.com/