Anatomical approach to the vascular segmentation of the spleen (lien) based on controlled experimental partial splenectomies

The basis for splenic segmental dearterialization: a post-mortem study

The anatomical features of splenic segmental vessels in 102 human spleen autopsy specimens were analyzed. Methods applied were corrosion casting and post-mortem arteriography. The superior terminal splenic branch divided extracapsularly into 2.8+/-0.9 (range 2-5) and the inferior terminal splenic branch into 2.3+/-0.75 (range 2-5) branches per sample. The extracapsular lengths of the segmental branches ranged from 4.0 to 16.7 mm and the calibers from 0.4 to 2.2 mm. Superior polar arteries occurred in 31.3% and inferior polar arteries in 20.6% of cases. Their average extracapsular lengths were 39 mm and 31 mm, respectively. In conclusion, segmental splenic arteries have an extrasplenic origin and course, with an average length and caliber that allow surgical access and ligation, in order to achieve segmental dearterialization for hemostasis purposes and splenic preservation.

Anatomic basis for conservative surgery of the spleen

100 pancreatico-splenic blocks obtained at autopsy were treated by the injection-corrosion method. The splenic artery ended in the lienorenal ligament in 64% of cases, in the pancreatic segment in 32% and in the hilar segment in 4%. In 84% of cases, the artery divided into two lobar arteries, upper and lower. In 16% the artery trifurcated. The pedicle was 20 to 60 mm long (mean 35 mm). The branches of the splenic artery were in three successive stages: the primary or lobar arteries were each associated with a lobe; the secondary or segmental arteries each supplied one of the constituent segments of a lobe; the tertiary or subsegmental arteries supplied the various areas which made up a splenic segment. Nine cases of extraparenchymal anastomoses were found. There were 32 intraparenchymal anastomoses, being either interlobar or intersegmental. There were a few interlobar anastomoses. The findings support the notion of upper and lower intersegmental and interlobar planes. The latter is almost avascular, while the former has limited vascularity. These planes make conservative surgery of the spleen possible.

Arterial segmentation in the spleen

The authors have conducted a corrosion cast study of the human spleen to systematize the branches of the splenic artery and the vascular territories irrigated by them. The existence of two primary divisional or lobar branches of the splenic artery and their respective territories or lobes is confirmed. The secondary or segmental branches and their vascular territories were studied; an average of 6 segmental territories was found. These findings are compared with those reported in the literature.

Anatomicosurgical segments of the human pancreas

Two anatomicosurgical segments of the human pancreas were recognized in 30 corrosion casts after injection of the pancreatic arteries thus confirming prior anatomico-surgical studies. The right (cephalocervical) and the left (corporocaudate) segments of the pancreas are separated by a paucivascular area. They are linked by the pancreatic duct and often by a single, small artery, which may be a branch of the gastroduodenal, gastroepiploic (gastromental), or dorsal pancreatic artery. Both segments are suitable for segmental pancreas transplantation.

Risk of splenic salvage after trauma. Analysis of 200 adults

This review was undertaken to analyze critically the complications resulting from operative splenic salvage. Over a 6 year period, 200 adults who sustained splenic trauma underwent laparotomy. The mechanism of injury was blunt in 138 patients (69 percent), a stab wound in 32 patients (16 percent), and a gunshot wound in 30 patients (15 percent). Splenorrhaphy was accomplished in 85 patients (42 percent). Methods of repair included cautery and hemostatic agents in 24 patients (28 percent), debridement and suturing in 42 patients (50 percent), and partial resection in 19 patients (22 percent). Six patients died, four from head trauma and two from multiple organ failure. Postoperative complications occurred in 14 patients. Four were intraabdominal. Three patients required reoperation for splenic hemorrhage; one (2 percent) after suture repair and two (11 percent) after partial resection. A left subphrenic abscess developed in another patient. Splenic reimplantation was performed in 43 patients (22 percent). Five deaths occurred. One was due to head trauma, three to multiple organ failure, and one to overwhelming pneumococcal infection. Eleven postoperative complications occurred, but none was related to splenic autotransplantation. Despite the enthusiasm for splenic salvage, the number of patients suitable for splenorrhaphy plateaued at 56 percent. Complications of splenorrhaphy are infrequent, and the risk increases with more complex salvage attempts. We believe that splenic reimplantation remains a safe procedure.