1. Universidad de Guadalajara
Centro Universitario Ciencias de la Salud
Spleen
Giovanna Lazcano Sherman
Dr. Héctor Manuel Virgen Ayala
November 2011 Dr. Benjamín Robles Mariscal

2. Anatomy
Develops from
mesenchymal
cells in the dorsal
mesogastrium
during the fifth
week of gestation.

4. The
peritoneum
covering the
spleen, except in
the hilum.

5. 7cm
150 gr.
(80 -300 gr). 12 cm
3 – 4 cm

6. Ligaments
• Gastrosplenic • Splenophrenic
• Splenorenal • Splenocolic

7. Irrigation and venous drainage

8. Histology/Physiology

10. 1. Splenic
Trauma/Injury

11. 2. Hypersplenism

12. Cronic Lymphocytic
Leukemia
Is a B-cell leukemia that is
characterized by the
progressive accumulation
of relatively mature, but
functionally
incompetent, lymphocytes.
Splenectomy  for palliation of symptomatic
splenomegaly and for treatment of cytopenia related to
hypersplenism

13. Hairy cell leukemia
Splenomegaly, pancytopenia
, and neoplastic
mononuclear cells in the
peripheral blood and bone
marrow
Administration of purine analogues, as initial
treatment.  Splenectomy…massive enlargement
of the spleen or with evidence of hypersplenism.

14. Myelodysplastic
syndrome
The bone marrow is usually
replaced by fibrous tissue.
Splenectomy ...
* Hemolysis unresponsive to treatment.
* Symptoms esoplenomegalia graces of mass.
* Life-threatening thrombocytopenia.

15. Systemic mast cell disease
indolent
aggressive
Splenectomy
(thrombocytopenia)

16. Gaucher disease
Autosomal recessive disorder
caused by a deficiency of
beta-glucosidase.
(an enzyme that degrades the
sphingolipid
glucocerebroside)
Splenectomy for hypersplenism-related
pancytopenia. (leaving a remnant)

17. Wiskott-Aldrich syndrome
A X-linked recessive disease
characterized by
eczema, thrombocytopenia
(20,000 – 40,000) immune
deficiency, and bloody diarrhea
(secondary to the thrombocytopenia).
Splenectomy normalizes the shape, size
and function of platelets. (Increased survival).

18. Sarcoidosis
Granulomatous
disease of unknown
origin.
Splenectomy for hypersplenism-
related pancytopenia.

19. 3. Disorder
Autoimmune/Erythro
cyte

20. Hereditary spherocytosis
Hemolytic anemia, the
deficiency of
membrane proteins
(spectrin, ankyrin and
protein 4-2)
Characterized by
sphere-shaped
red blood cells.

21. Hereditary elliptocytosis
Only 10% are symptomatic  Splenectomy

22. Hereditary nonspherocytic
hemolytic anemia.
• Anaerobic
metabolism
(energy).
• Production of
antioxidants
(glutathione)
Splenectomy is not curative but
improve some conditions.

23. Immune hemolytic anemia
• IgM
• IgG
Splenectomy

24. Immune Thrombocytopenic
Purpura
IGg 
fibrinogen
receptor

25. Treatment
Mild symptoms or asymptomatic ... not require specific
treatment.
Corticosteroids.
Splenectomy

26. Felty’s syndrome
Rheumatoid arthritis
Neutropenia Splenomegaly
IgG

27. Trombotic
trombocitopenic purpura
• Fever
Plasmapheresis
• Thrombocytopenic
purpura
Splenectomy
• Hemolytic anemia
• Neurologic
manifestations
• Renal failure

28. 4. Vascular
disease.

29. Splenic vein thrombosis
20%

30. 5. Cysts, abscesses
and primary splenic
tumors.

31. Cysts
Rx calcification in the cyst wall
Primary
Splenic tumors Abscesses
• Lymphoma 40-100% mortality
• Sarcoma Rx  Presence of gas
in the spleen
• Hemangioma
(pathognomonic)
• Hamartoma CT  Diagnostics

32. 6. Diagnostic
splenectomy

33. Single lesions of the spleen
Malignant
lesions 60%
Benign
lesions 40%

34. 7. Incidental
splenectomy

36. 8. Iatrogenic
splenectomy

37. Splenectomy most common ...
40 - 50% Hematologic disorders.
35 - 40% Trauma.
20 -30% Neoplastic disease.
Immune Thrombocytopenic
Purpura has the highest incidence