The document discusses the splenic ligaments and blood supply. It contains descriptions of emergency and elective splenectomy procedures. For emergency splenectomy, a midline incision is made to access the peritoneal cavity and pack any active bleeding from the spleen. The lesser sac is then entered to detach the spleen from its avascular attachments. For elective splenectomy of an enlarged spleen, a left subcostal or thoracoabdominal incision provides exposure, and vessels up to 7 mm in diameter must be controlled to prevent hemorrhage.

2. FIGURE 170.2. SPLENIC LIGAMENTS AND ATTACHMENTS ALONG WITH THE SPLENIC
BLOOD SUPPLY THE GASTROSPLENIC LIGAMENT CONTAINS THE SHORT GASTRIC VESSELS THAT
EXTEND FROM THE UPPER POLE VESSELS AND ALSO CONTAINS THE POSTERIOR GASTRIC VESSELS THAT
ARISE FROM THE SPLENIC VESSELS APPROXIMATELY 4 CM PROXIMAL TO THE SPLENIC HILUM. THE
SPLENOCOLIC LIGAMENT ALWAYS CONTAINS AT LEAST TWO SMALL VESSELS, WHEREAS THE
SPLENOPHRENIC AND SPLENORENAL LIGAMENTS HAVE NO NAMED VESSELS.

4. EMERGENCY SPLENECTOMY
• MIDLINE INCISION GIVES RAPID ACCESS TO THE PERITONEAL
CAVITY WITH GOOD VISUALIZATION OF ALL ORGANS INCLUDING
THE SPLEEN
• THE ACTIVELY BLEEDING SPLEEN SHOULD BE PACKED IN ORDER TO
OBTAIN TEMPORARY HEMOSTASIS WHILE FULL SPLENIC EXPOSURE
IS ACCOMPLISHED
• THE LESSER SAC IS ENTERED THROUGH THE GREATER OMENTUM
OUTSIDE THE ARCADES OF THE GASTROEPIPLOIC VESSELS (FIG.
170.3).
• THE SPLEEN CAN THEN BE DETACHED FROM ITS “AVASCULAR”
SPLENOPHRENIC AND SPLENONEPHRIC ATTACHMENTS

5. ELECTIVE SPLENECTOMY
• When patients with a small spleen require elective splenectomy, a left subcostal incision
provides excellent exposure
• A thoracoabdominal incision excising the eighth or ninth rib and extending medially to
the linea alba allows safe exposure to the huge spleen.
• The diaphragm is divided to the hiatus. The vessels are huge with the splenocolic veins
being 5 mm in diameter, the short gastric vessels 5 to 7 mm in diameter, and the splenic
vein 3 to 4cm in diameter. The wide exposure permits bloodless control of all named and
unnamed vessels to prevent rapid lethal hemorrhage.