Structure and function of the spleen

The spleen combines the innate and adaptive immune system in a uniquely organized way. The structure of the spleen enables it to remove older erythrocytes from the circulation and leads to the efficient removal of blood-borne microorganisms and cellular debris. This function, in combination with a highly organized lymphoid compartment, makes the spleen the most important organ for antibacterial and antifungal immune reactivity. A better understanding of the function of this complex organ has been gained from recent studies, as outlined in this Review article. [1]

Conservation of the Spleen With Distal Pancreatectomy

This report describes a rapid, easy, and safe means of saving the spleen while resecting or fully mobilizing the pancreatic tail. The pancreas is separated from the spleen by dividing the splenic artery and vein distal to the tip of the pancreas. The spleen survives on the short gastric vessels, which are carefully preserved. The technique has been applied successfully in 22 of 25 consecutive patients with chronic pancreatitis (n=13), acute pancreatitis and pancreatic necrosis (n=3), cystic neoplasm of the pancreas (n=4), islet cell tumor (n=2), and ductal adenocarcinoma (n=3). The spleen could not be saved in three patients because of splenic hilar involvement by tumor or scar. Normal postoperative blood cell counts and spleen scans proved splenic viability and function. There was only one complication, a late splenic abscess that developed in a spleen of twice-normal size. It is concluded that in most instances the distal pancreas can be mobilized for resection or inspection without the need for splenectomy. Splenomegaly may be a contraindication because the short-vessel gastric blood supply may be inadequate to nourish the increased tissue mass. The technique is applicable to the treatment of pancreatic tumors, trauma, and pancreatitis. [2]

Organ injury scaling: spleen, liver, and kidney.

The Organ Injury Scaling (O.I.S.) Committee of the American Association for the Surgery of Trauma (A.A.S.T.) was appointed by President Trunkey at the 1987 Annual Meeting. The principal charge was to devise injury severity scores for individual organs to facilitate clinical research. The resultant classification scheme is fundamentally an anatomic description, scaled from 1 to 5, representing the least to the most severe injury. A number of similar scales have been developed in the past, but none has been uniformly adopted. In fact, this concept was introduced at the A.A.S.T. in 1979 as the Abdominal Trauma Index (A.T.I.) and has proved useful in several areas of clinical research. The enclosed O.I.S.’s for spleen, liver, and kidney represent an amalgamation of previous scales applied for these organs, and a consensus of the O.I.S. Committee as well as the A.A.S.T. Board of Managers. The O.I.S. differs from the Abbreviated Injury Score (A.I.S.), which is also based on an anatomic scale but designed to reflect the impact of a specific organ injury on ultimate patient outcome. The individual A.I.S.’s are, of course, the basic elements used to calculate the Injury Severity Score (I.S.S.) as well as T.R.I.S.S. methodology. To ensure that the O.I.S. interdiffuses with the A.I.S. and I.C.D.-9 codes, these are listed alongside the respective O.I.S. Both the currently used A.I.S. 85 and proposed A.I.S. 90 are provided because of the obligatory transition period. Indeed, A.I.S. 90 contains the identical descriptive text as the current O.I.S.’s. The Abdominal Trauma Index and other similar indices using organ injury scoring can be easily modified by replacing older scores with the O.I.S.’s. [3]

Splenic Rupture after Infective Endocarditis by Enterococcus faecalis: Case Report

Aims: In patients with infective endocarditis, with risk of embolization, early identification of parenchymal changes may suggest the risk of splenic rupture.

Presentation of Case: A 68-year-old male presented with a history of 2 months of fever and also left upper quadrant pain initiated 2 days before admission. Transesophageal echocardiogram demonstrated the presence of two mobile vegetations on the ventricular side of the aortic valve; the largest diameter being 2.1 cm. Enterococcus faecalis was isolated in blood culture after a diagnosis of subacute aortic valve infective endocarditis. He complained of abdominal pain. An abdominal computed tomography scan revealed infarction of the upper region of the spleen (septic embolism). Therapy with penicillin and gentamicin was initiated, but the patient developed symptoms of heart failure that led to a surgical treatment, and aortic bioprosthesis was implanted on day 14. On day 5 postoperatively, the patient developed sudden hemorrhagic shock signs due to splenic rupture and underwent emergency splenectomy. A pathological examination revealed areas of splenic laceration of the capsule, splenic infarction areas, and the absence of abscesses. Splenic rupture is a complication much rarely occurring due to infectious endocarditis caused by E. faecalis.

Conclusion: This case highlights the importance of conducting serial imaging, particularly in symptomatic patients, for the early detection of parenchymal changes that may suggest the risk of rupture. [4]

Splenic Rupture in Plasmodium vivax Malaria: A Case Report from Kuwait

We describe a case of malaria vivax in a 31 year old Afghan male complicated by spontaneous splenic rupture one month after returning from Pakistan. The ruptured and enlarged spleen displaying multiple subcapsular hemorrhages was surgically resected. Malaria was diagnosed by peripheral blood smear. The patient underwent antimalarial therapy with chloroquine and primaquine. While numerous diseases can result in splenic complications, such as splenic rupture malarial infection is known as the most common cause. Consequently, It is recommended that malaria be always considered in all cases of suspected splenic rupture in the differential diagnosis of all acute fevers, especially among those with a history of travel to an endemic area. [5]

Reference

[1] Mebius, R.E. and Kraal, G., 2005. Structure and function of the spleen. Nature reviews immunology, 5(8), pp.606-616.

[2] Warshaw, A.L., 1988. Conservation of the spleen with distal pancreatectomy. Archives of surgery, 123(5), pp.550-553.

[3] Moore, E.E., Shackford, S.R., Pachter, H.L., McAninch, J.W., Browner, B.D., Champion, H.R., Flint, L.M., Gennarelli, T.A., Malangoni, M.A. and Ramenofsky, M.L., 1989. Organ injury scaling: spleen, liver, and kidney. The Journal of trauma, 29(12), pp.1664-1666.

[4] Macedo, T., Amaral Baruzzi, A., Barros e Silva, P., Alves, F., Hames, R., Sampaio, M., Garcia, J. C. and Furlan, V. (2015) “Splenic Rupture after Infective Endocarditis by Enterococcus faecalis: Case Report”, Journal of Advances in Medicine and Medical Research, 13(2), pp. 1-4. doi: 10.9734/BJMMR/2016/23389.

[5] Al-Fadhli, M., Al-Fadhli, A.-A., Saraya, M. and Qasem, J. A. (2015) “Splenic Rupture in Plasmodium vivax Malaria: A Case Report from Kuwait”, Journal of Advances in Medicine and Medical Research, 8(12), pp. 1063-1067. doi: 10.9734/BJMMR/2015/17170.