ABSTRACT
Declared by Galen as the organ of mystery (organum mysterium), thought of by many as the organ that clears ‘‘melancholic residues,’’ and discussed by giant physicians and philosophers like Hippocrates, Aristotle, Vesalius, Malpighi, and Billroth, the spleen remains today an organ of great interest to anatomists, physicians, and surgeons. It was not until well into the 20th century that our knowledge of the spleen began to take its current shape. A report in 1929 of a case of postsplenectomy sepsis and the recognition by King and Schumacker of this entity in 1952 questioned the previous assumption of the expendability of the spleen. The description by Christo in 1962 of the segmental anatomy of the spleen helped surgeons perform a partial splenectomy, thus decreasing the risk of postsplenectomy sepsis. The application of modern diagnostic tools like computed tomography (CT) scans and modern techniques like laparoscopy has revolutionized splenic surgery, and few will disagree now that one should attempt to save the spleen when possible and that caution is of ultimate importance when the decision of splenectomy is made. This chapter describes the current knowledge of the surgical physiology and pathophysiology of the spleen and places particular emphasis on splenectomy, its indications and complications, and suggested alternative procedures.
The spleen is a solid, purplish-red organ located in the posterior left uppermost quadrant of the abdomen at the level of the 8th to 11th ribs (Fig. 1). Its adult weight is around 150 g ranging between 50 and 300 g and usually decreasing by weight and size with age (1). According to Michels, the spleen has three potential shapes: wedge (44%), tetrahedral (42%), or triangular (14%) (2). These shapes are determined, in part, by the organs that it abuts, principally the diaphragm, stomach, and left kidney (Fig. 1). The eight splenic ligaments are surgically important because they must be divided during splenectomy. The four major ligaments include the splenorenal, splenocolic, splenophrenic, and gastrosplenic ligaments (Fig. 1). With the exception of the latter, these suspensory ligaments are largely avascular unless the patient has advanced portal hypertension. The gastrosplenic ligament, however, is usually vascular and contains the short gastric vessels (Fig. 1). The other four ligaments with splenic attachments are the presplenic fold, the pancreaticosplenic, phrenicocolic, and pancreaticocolic ligaments. Although surgically less important, these minor ligaments can lead to injury of the spleen or its neighboring organs with careless traction or incision (2).
