THE SPLEEN Dr Zaeem Fezea Dahla Consultant general

THE SPLEEN Dr Zaeem Fezea Dahla Consultant general surgeon CABS

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 � The benefit of splenic conservation � The importance of prophylaxis against infection following splenectomy.

EMBRYOLOGY , ANATOMY , AND PHSIOLOGY �Embryology

Splenomegaly and hypersplenism Infective BACTRIAL : Typhoid , PT Biogenic abscess VIRUS Spirochete s Parasite Bilharzia, Malaria Salazar Blood disease NEOPLA CONGES COLLAG TIVE STIC METABO EN POTAL LYMPHOMAP FELTY DISEAASE HYPERTENSION LIC Leukemia HEMANGIOMA Anemia Polycythemia SARCOMA ITP Hemolytic anemia GOUCHER DISEASA AMYLODOSIE RICKETS 9 TILL’S disease

�Congenital anomalies of the spleen �SPLENIC AGENESIS; it is rare , about 10% of children with heart disease having such anomaly. �Splenunculi; single or multiple accessory spleen that are found in approximately 10 -30% of population they are located near the hilum of the spleen in 50% of cases, or along the vessels of the spleen, or tail of the pancreas in 30% � HAMARTOMA; it is rare , it is the size of 1 cm in diameter � NON parasitic splenic cyst; it is divided into primary(true) cyst , or secondary (pseudocyst)

SPLENIC ARTERY ANEURYSM, INFARCT AND RUPUTRE � It is rare condition 0, 04 -1% found in post-mortem examinations , twice as common in female as in male , it is usually single but may be multiples. detected by plain x ray or scan of the abdomen , half of cases of rupture occur in patients around 45 years. � Treatment either splenectomy , ligation or embolization for artery disease , for splenic infarction treatment are splenectomy or conservative. Rupture treatment deepened on grade of laceration

leukaemia �Splenectomy is reserved for hypersplenism that occurs during the chronic phase of granulocytic leukaemia. �Haemolytic anaemias ; there are 4 causes of haemolytic anaemia that are generally amenable to splenectomy(hereditary spherocytosis , acquired autoimmune haemolytic anaemia , thalassaemia, sickle cell disease, ) �Leukaemia should be considered in differential diagnosis of splenomegaly.

NEOPLASMS OF SPLEEN �Hemangioma is the most common benign tumor of the spleen �Spleen is rarely the site of metastatic disease. �Lymphoma is the most common cause of neoplasm enlargement. �Splenectomy is the role.

Splenectomy indications; �Trauma �Removal en bloc , like CA stomach �To reduce anemia or thrombocytopenia in spherocytosis, ITP, hypersplenism. �In association with shunt surgery in portal hypertension

�Preoperative preparation; A. Technique of open splenectomy B. Technique of laparoscopic splenectomy

postoperative complications �Immediate post op. bleeding, haematoma �Haematemesis from gastric mucosal damage & gastric dilation �Atelectasis �Damage to tail of pancreas �Post splenectomy sepsis syndrome , the risk is greater in first 2 -3 ys post splenectomy

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