the amount of pus - up to hundreds of ml, it is usually mature,
omentum is usually attached to the abscess,
clinical picture,
both of these units are characterized by general septic manifestations and a small local finding,
important symptom – induced pleurisy, higher position of the diaphragm.
Other
tuberculosis – rare today,
sarcoidosis – moderate splenomegaly (500–700 g), also very rare, often only an incidental histological finding during splenectomy for another indication,
actinomycosis - usually as part of a disease in another location,
parasitic splenomegaly,
malarial spleen – huge, prone to rupture even with minimal trauma,
echinococcal cyst - it is rare in the spleen, more in the lungs and liver,
viral – e.g. with mononucleosis.
Spleen surgery
Preserving methods
Suture
In minor ruptures, especially in children (the capsule is stronger, stitches are cut less),
we sew atraumatically, it is advantageous to underline the contractions with a Teflon plate or to sew a piece of omentum (and a tampon) there.
Compression of the spleen with mesh
For multiple tears, when suturing would be difficult and the bleeding is not so great.
Resection of the spleen
For tears that affect the upper or lower part of the spleen,
ligation of the segmental branches in the hilum, thereby demarcating the ischemic part, which is then resected,
it is advantageous to treat the wound surface with glue or omentum,
non-anatomical resections – using some modern staplers.
Implantation of spleen tissue (autotransplantation)
Dark red nodules are implanted splenic tissue after splenectomy due to traumatic rupture of the spleen
When the spleen cannot be preserved,
we try to do this with children and young people,
most often, the tissue is implanted between the leaves of the omentum, under the peritoneum, less often outside the abdominal cavity,
however, it is necessary to implant at least 1/3 of the original organ.
Splenectomy
Advances in the pharmacology of blood malignancies have slightly limited the indications for splenectomy,
new procedures are also starting to be used (laparoscopy, etc.).Error creating thumbnail: CT of traumatic rupture of the spleen
Indications for splenectomy
There are big changes in the indication area (as one begins to realize what the spleen is actually for), while it is practically contraindicated in children under two years of age, it is almost always performed in children (smaller postoperative risks when removing the entire spleen than when trying to preserve it),
injury – if conservative treatment is not possible,
hematological indications – it is initiated by a hematologist,
many indications are relative - we must take into account whether the effect of splenectomy balances the risk of performance and asplenism,it is also performed as part of extensive radical operations for GIT malignancies,
indications for trauma – severe parenchymal rupture, injury to the spleen in polytrauma, damage to hilar vessels,
other indications - spleen abscess, cyst, part of resection procedures for GIT organ cancers, spleen torsion, ileus from pressure of an enlarged spleen, portal hypertension - proximal splenorenal junction.
