Dr AbdAllah Hawari , MRCSI

General and Laparoscopic surgeon

Head of endscopic surgery unite,
Al-Makassed hosp. AlQuds
 Function of the spleen
1. Immune function
2. Filter function removal of effete ,platelets, red cells
which called (culling process)
3. Pitting: removing of particulate inclusion RBCs from
the circulation.
4. Culling: is the removal of abnormal RBCs.
5. Iron reutilization.
6. Pooling: up to 30-40% of plt seq., in spleenomegaly
up to 80% of plt seq. in spleen.
7. Reservoir function
8. Haematopoiesis ( intrauterin 5th month)
• Splennuculi:
could be single or multiple accessory spleen
which are found near the hilum in 50% of the
cases , and related to the splenic vein and behind
the pancreatic tail in 30%. Or the splenic
ligament or mesocolon .
- mostly < 2cm .
-reported cases in the testes.
Spleenosis: occur due to implantation of splenic
tissue in the abdomen that get growth.
 Trauma of the spleen
• Could be involved in blunt or penetrating injury .
• The most common involved organ in blunt
trauma.
• Splenic injury should be suspected in any blunt
trauma , weither direct to the LUQ or not .
• Falling down can make injury to the spleen, with
out direct trauma , especially in enlarge spleen
(CMV, malaria )
Patient with injured spleen presented
as one of three group
1. The patient succumbs rapidly from massive
bleeding , but this rarely occur in normal
spleen.
2. Initiale shock , then recovery and has sign of
bleeding . The initial shock due to bleeding
the get tamponad , then gradual bleeding .
The signs of bleeding variable ,depend on the
amount of blood loss .
3- the delayed cases : the initial sign has been
pass off , the patient asymptomatic , or
missed , the delyed rupture occur.
• The best tools to evaluate the spleen for
trauma are the C T scan , or the good US
study .
• The US considered to be part of (FAST)
evaluation of trauma patient in the ER .
• CT scan used to evaluate the grade of injury
and evaluate the other organs.
Grads of spleen injury
G- I
G- II
G- III
G -IV
G- V
G- V
G- V
 If we haven't US or CT scan
We do plain X-ray looking for:
1.Obliteration of splenic shadow
2.Obliteration of psoas shadow
3.Indentation of the Lt side of gastric air bubble
4.# of one or more Lt lower ribs
5.Elevation of the Lt hemi-diaphragm
6.Free fluid between the gas filled bowel loops
 Infections of the Spleen (Splenic Abscess)

• Splenic abscesses are uncommon but are

important because the death rate ranges
between 40% and 100%.
• In 80% of cases, one or more abscesses exist
in organs other than the spleen, and the
splenic abscess develops as a terminal
manifestation of uncontrolled sepsis in other
organs
• Most splenic abscesses remain localized,
periodically seeding the bloodstream with
bacteria, but spontaneous rupture and
peritonitis may occur
 TREATMENT
• Splenectomy is essential for cure if sepsis is
localized to the spleen
• Percutaneous drainage of large, solitary
juxtacapsular abscesses may occasionally be
feasible but is associated with an extremely
high mortality rate and should be reserved for
patients unable to withstand an operation
 Splenic Vein Thrombosis

• Thrombosis of the splenic vein can occur as an

isolated event not due to any pathologic findings
in the spleen but due to diseases that impact the
splenic vein as it travels along the superior
border of the pancreas
• The most common cause is acute or chronic
pancreatitis or a pseudocyst of the body/tail of
the pancreas, with the general inflammatory
reaction in the pancreas resulting in thrombosis
of the splenic vein in 20% of patients.
• Splenic vein thrombosis presents as upper
gastrointestinal hemorrhage due to isolated
gastric varices
 CAUSES
OF
SPLENOMEGALY
 Typhoid and paratyphoid
 Typhus
 Anthrax
 TB
 Septecemia
 Abscess of the spleen
 Weil’s disease
 Syphilis
 CMV
 Psitticosis
 Malaria
 Schistosomiasis
 Trypanosomiasis
 Kala-azar
 Hydatid cyst
 Tropical splenomegally
• Myelofibrosis
• Acute leukemia
• Chronic leukemia(lymphocytic and granulcytic )
• Pernicious anemia
• Polycythemia vera
• Erythroblastosis fetalis
• Hereditary sherocytosis
• Autoimmun-hemolytic anemia
• ITP
• Thalassaemia
• Sikle cell disease
• Rickets
• Amyloidosis
• Prophyria
• Gaucher’s disease
• Infarction
• Infective endocarditis
• Portal hypertension
• Mitral stenosis
• Thrombophlebitis
• Occlusion of the portal vein
• Still’s disease
• Felty’s syndrom
• -congenital
• -acquired
• Angioma
• Primary fbrosarcoma
• Hodgkin’s lymphoma
• Other lymphoma
• (1) Hypersplenism is characterized by diffuse
enlargement of the spleen by neoplastic
disorders, hematopoietic disorders of the
bone marrow, and metabolic or storage
disorders.
• (2) Autoimmune/erythrocyte disorders.
Specific cytopenias are related either to
antibodies targeting platelets, erythrocytes, or
neutrophils.
• (3) Trauma or injury to the spleen.
• (4) Vascular diseases. Splenic vein thrombosis
and splenic artery aneurysm may require
splenectomy for treatment.
• (5) Cysts, abscesses, and primary splenic
tumors are mass lesions of the spleen. This
category includes treatment of simple cysts,
echinococcal cysts, splenic abscess, and
various benign neoplasms, including
hamartomas, hemangiomas, lymphangiomas,
and rare malignant lesions.
• (6) Diagnostic procedures.
• (7) Iatrogenic splenectomy.
• (8) Incidental splenectomy.
 POST SPLENECTOMY CARE
• Leukocytosis is usually observed after
splenectomy and may last up to a few
months. It is characterized by a
preponderance of granulocytes.
Thrombocytosis is also encountered in most
patients but is rarely associated with
thrombotic events
 Complications associated with
splenectomy
• splenic rupture,
• hemorrhage,
• postsplenectomy septicemia,
• subphrenic abscesses,
• necrosis of the fundus of the stomach,
• injury to the tail of the pancreas,
• atherosclerotic heart disease.
• The presence of remnant accessory spleens
in instances of splenectomy for hematologic
disorders may be associated with relapse of
the underlying disease
 OVERWHELMING POSTSPLENECTOMY
INFECTION
• Overwhelming postsplenectomy infection
(OPSI) is a life-threatening potential
complication seen in asplenic individuals that
gained significant acceptance in 1953 after an
observation by King and Shumacker
OVERWHELMING POSTSPLENECTOMY
INFECTION
• OPSI is encountered with greatest frequency
within 2 years after splenectomy, in the very
young, in patients with other medical
complications, and in those with
malignancies
OVERWHELMING POSTSPLENECTOMY
INFECTION
• The risk of postsplenectomy sepsis increases
according to the indications for splenectomy.
Trauma, hematologic disorders, portal
hypertension, Hodgkin's disease, sickle cell
disease, and thalassemia represent
increasing cumulative indices of sepsis,
ranging from 1.5% to 25%, respectively
OVERWHELMING POSTSPLENECTOMY
INFECTION
• OPSI occurs mostly in association with
encapsulated organisms that require
opsonization for effective phagocytosis. The
most frequent such pathogens are Neisseria
meningitides, Hemophilus influenzae type b,
and Streptococcus pneumoniae
OVERWHELMING POSTSPLENECTOMY
INFECTION
• There are effective vaccines against all of
them, and it is recommended that they be
administered 3 weeks prior to splenectomy
to allow for a more effective immune
response
OVERWHELMING POSTSPLENECTOMY
INFECTION
• Focal infections such as meningitis are more
frequent in children younger than 5 years of
age.
OVERWHELMING POSTSPLENECTOMY
INFECTION
• OPSI usually follows a rapid course, evolving
into sepsis and disseminated intravascular
coagulation; 80% of deaths occur within the
first 48 hours.
• Asplenic patients who develop fever should
be immediately evaluated and promptly
treated with broad-spectrum intravenous
antibiotics