Lower Pole Of Spleen Research Articles

Hydatid Cyst at Unusual Location (Spleen) - A Case Report

Echinococcosis or Hydatid disease is a zoonosis endemic in agricultural areas of the world. It is caused by tapeworm of genus Echinococcus excreted in the faeces of infected dogs. Most common site of involvement is liver (50-77%) followed by lungs (18-35%), abdominal cavity and brain. Splenic hydatid cyst is a rare entity constituting 0.5 - 4% of abdominal hydatid disease. We report a case of 62 yrs old female who presented with vague abdominal pain and vomiting. Her abdominal CECT revealed a cystic lesion with peripheral calcified foci at lower pole of spleen. All other investigations were normal except for raised serum echinococcus IgG levels. Splenectomy specimen was received and histopathological examination confirmed it as hydatid cyst. Microscopy showed outer acellular laminated membrane, inner germinal layer with scolices along with eosinophilic inflammatory infiltrate. Patients presenting with hydatid disease are usually asymptomatic or can have vague abdominal pain. The disease is associated with recurrences, fatal anaphylaxis if neglected and high morbidity and mortality, therefore it should be considered as a differential for any cystic mass found in any part of the body.

Сравнительный анализ эффективности новых образцов местных гемостатических средств

Various local hemostatics (based on collagen, gelatin, cellulose, etc.) are used to stop bleeding from parenchymal organs of the abdominal cavity. In the context of an acute in vivo experiment, this study aimed to comparatively assess the time and volume of bleeding from a trauma of abdominal cavity's parenchymal organs covered with a new collagen-based spongy hemostatics combined with Na-CMC. We used new multicomponent polymer sponge implants (MPSI) based on marine collagen and carboxymethyl cellulose sodium salt, Na-CMC; the components were mixed in the ratios of 15/85, 25/75, 50/50. Hemostatic activity of the samples was assessed by bleeding time and blood loss volume. For the experiments, rats underwent laparotomy and resection of the left lobe of liver (series 1) and lower pole of spleen (series 2). In both series of experiments, the controlled parameters (bleeding time and blood loss volume) were smallest in group 6, where the MPSI were 50/50 Na-CMC/collagen. The hypothesis of higher efficacy of composite local hemostatic agents (namely, made of Na-CMC and deep-sea squid collagen) in cases of trauma of the parenchymal organs was confirmed experimentally, and same experiment has also shown that collagen in the composition of MPSI boosts bleeding arrest (for liver injury, the smallest blood loss and hemorrhage control time was 41 s, for spleen injury — 57 s, respectively; p ≤ 0.05).

Case report: Splenic hamartoma: A rare vascular benign tumor of spleen

Splenic hamartoma (or splenoma) is a rare, benign, vascular tumor, often incidentally found at imaging, surgery or autopsy. It is usually asymptomatic. We report a case of 53 yrs old female from Tumkur city which was incidentally found during evaluation for GERD who had a large (9*10*10) splenic mass with small cystic /necrotic areas arising from lower pole of spleen, moderate heterogeneous enhancement on post contrast study, histologically congested sinusoids along with white pulp comprised of lymphoid follicles and immunohistochemically positive for antibodies to T- and B-cells and immunoglobulin light chains, CD 34 and Factor 8.

Splenic Lymphangioma: A Rare Tumour of Spleen in Adults

Splenic Lymphangioma is a rare, benign, cystic lesion arising from malformations of splenic lymphatic channels. They are usually found in paediatric population and rarely in adults. Isolated lesions are asymptomatic and detected incidentally. However larger lesions present with abdominal discomfort, loss of appetite or a palpable mass. Surgical removal of spleen remains the treatment of choice. A 25-year-old, unmarried female presented 2 months history of pain epigastrium. Abdominal ultrasonography revealed a well defined hypoechoic area in relation to the lower pole of spleen with normal splenic and portal vein. Computed tomography with contrast enhancement showed mild splenomegaly with multiple hypodense lesions with peripherally enhancing rim and decreased central attenuation with likely possibility of angiosarcoma of spleen. JMS 2018: 21 (2):122-124

How to reduce splenic injury in laparoscopic radical gastrectomy: Criminal ligament priority separating.

e15528 Background: Iatrogenic splenic injury may lead to conversion or nontherapeutic splenectomy in laparoscopic gastrectomy. A critical point at splenic injury occurs is improper traction of spleen-omentum ligament which was called crimimal ligament (CL). We aimed to explore the efficacy of cirminal ligament priority separating (CLPS) to reduce iatrogenic splenic injury in laparoscopic radical gastrectomy. Methods: Complete videos of 540 laparoscopic radical gastrectomy in Guangdong Provincial Hospital of Chinese Medicine were reviewed. The relationship between CLPS and iatrogenic splenic injury was determined. CL was defined as the ligament between omentum and spleen. CLPS was defined as that CL was firstly separated when mobilization was in left upper quadrant. Results: CL was present in 81.5% (440/540) and were included for analysis. There was variation in the distribution pattern of CL and it mostly appeared in the lower pole of spleen (414/440). CLPS was performed in 24.5% (108/440) and 75.5% (332/440) were not (un-CLPS). In systematic review, the incidence of iatrogenic splenic injury was 10.9% (48/440). Among these patients, 79.1% (38/48) were due to improper traction of CL and they were all in un-CLPS group. Instrument injury was occurred in 2.2% (10/440) and 3 were in CLPS group and 7 were in un-CLPS group. Most iatrogenic splenic injury were successfully handled with electrocoagulation, adhesive and compression technique, except 2 patients underwent conversion to open splenectomy for serious splenic injury in un-CLPS group. Conclusions: In laparoscopic surgery for gastric cancer, iatrogenic splenic injury mostly resulted from improper traction of CL and CLPS could reduce the incidence of iatrogenic splenic injury.

CT Scan Mapping of Splenic Flexure in Relation to Spleen and its Clinical Implications

Splenic flexure mobilization is a challenging step during left colon resection. The maneuver places the spleen at risk for injury. To minimize this risk, we conducted this study for CT scan mapping of splenic flexure in relation to the spleen. One hundred and sixty CT scans of abdomen were reviewed. The level of the splenic flexure was determined in relation to hilum and lower pole of spleen. These levels were compared with patient demographics. Statistical analysis was performed using Fisher's exact test. The splenic flexure was above the hilum of the spleen in 95 patients (67.86%), at the splenic hilum level in 11 patents (7.88%), between the hilum and lower pole of the spleen in 12 (8.57%), at the lower pole of the spleen in 15 (10.7%) patients and 7 (5%) patients has a splenic flexure that lied below the lower pole of the spleen. Patient demographics showed no statistical significance in regard to splenic flexure location. Splenic flexure lies above the hilum of the spleen in majority of patients. This should be considered as part of operative strategies for left colon resection.

Totally laparoscopic complete bursectomy and D2 lymphadenectomy in radical total gastrectomy: an outside bursa omentalis approach.

Bursectomy is regarded as a standard surgical procedure during gastrectomy for serosa-positive gastric cancer in Japanese gastric cancer treatment guidelines (Japanese Gastric Cancer Association in Gastric Cancer 14:113-123, 2011). As a consequence, bursectomy is widely performed in open gastrectomy. However, laparoscopic gastrectomy with bursectomy is rare. Based on our previous experience of laparoscopic bursectomy in distal gastrectomy (Zou et al. in Oncol Lett 10:99-102, 2015), herein, we described the technique of totally laparoscopic radical total gastrectomy with complete bursectomy using an outside bursa omentalis approach. Firstly, the transverse mesocolon and distal gastric membrane were separated from right to left, and the right gastroepiploica vessels were ligated at root with No. 6 lymph nodes (LNs) dissection followed by the pancreas membrane dissection from pancreas head to pancreas tail. Secondly, the anterior plane of transverse mesocolon was dissected from left to right starting from the lower pole of spleen, and the membrane of pancreas tail was separated to combine the pancreas anterior plane with No. 4s, 10, 11d and 2 LNs dissection. Thirdly, the lesser omental was dissected from right to left with No. 5 and 12a LNs dissection, and the duodenum was transected. Then, the No. 7, 8, 9 and 11p LNs were dissected followed by No. 1 LNs dissection. Finally, a Roux-en-Y esophagojejunostomy was carried out intracorporeally with a linear cutter. Thirty-two patients with advanced proximal gastric cancer underwent laparoscopic total gastrectomy with complete bursectomy using an approach outside bursa omentalis. One bowel obstruction and one pulmonary infection were recorded and cured with conservative measure. The mean operative time was 253.3±31.3min with a mean blood loss of 90.5±23.1ml. The mean length of stay was 10.6±2.6days. Laparoscopic radical total gastrectomy with complete bursectomy using an outside bursa omentalis approach is feasible and safe in experienced hands with favorable short outcome. Further studies were needed for its advanced application.

Study of diameter, length, tortuosity of splenic artery and its branches with its clinical implications

Background: Systematic knowledge of the splenic arterial vasculature would provide greater safeguards in the design of the surgical techniques but there are surprisingly few studies on the subject. For this reason, we studied morphological anatomy of splenic artery. Aims: To study morphological anatomy of splenic artery and clinical implications. The present study aims to report length, tortuosity, diameter of splenic artery and its branches. Material and Method: The measurements were taken on 50 donated embalmed cadavers irrespective of the sex in the Department of Anatomy, MGM Medical College, Navi Mumbai, Maharashtra. The findings were noted after dissection. The study was carried out between May 2009 to December 2012. Results: The mean length of splenic artery with tortuosity was 9.52 cm. The mean length of splenic artery without tortuosity was 12.76 cm. The splenic artery shows numerous tortuosities. The tortuosity decreases as the diameter increases. We found that superior polar branch was slender and thin can be easily damaged. To avoid this operation should start from inferior pole. The mean diameter of splenic artery was 5.144 mm that of superior ramus was 4.340 mm and inferior ramus was 3.760 mm. So we found weak inferior ramus supplying the lower pole of spleen. Due to which inferior pole was also supplied by additional branches. Conclusion: Knowledge of splenic artery has the clinical significance in planning and conducting procedures such as partial or total splenectomy, splenic aneurysm, splenic embolisation, splenography, surgical and radiological procedures of upper abdominal region to avoid any complications. Key words: splenic artery, length, diameter, tortuosity

Malignant fibrous histiocytoma of the spleen

Introduction. Since the first description of primary splenic malignant fibrous histiocytoma given by Govoni et al. in 1982, there have been only 18 reported cases by the end of 2013. We herein reported a case of rare primary malignant fibrous histiocytoma of the spleen with liver metastases and unspecific general symptoms. Case Report. A 62-year-old cachectic female complained of sharp strong abdominal pain (on the pain scale 8/10) and distaste for food on admission at Primary Care Service on March 29, 2014. On physical examination, palpable painful 2 cm long tumefact in the left hypochondriac segment was found. Laboratory findings showed leukocytosis 17.9 x 109/l, erythrocyte sedimentation rate of 55 mm/h, C reactive protein 25.8. Magnetic resonance of abdomen proved secondary deposits in the right liver segment and lower pole of spleen. Positron emission tomography-computed tomography recorded a cold necrosis field in the right liver part and lobulated cystic formation of spleen. After radiological examination, splenectomy and resection of the pancreas cauda were performed. Primary malignant splenic fibrous histiocytoma with liver metastases was proved histopathologically. The patient was given three chemotherapeutic series until October 2, 2014 and she is now in good general condition. Conclusion. The possibility of primary malignant splenic fibrous histiocytoma should be considered in every case with proved intra-abdominal masses of unknown origin. Clinical and laboratory findings are unspecific. Surgical resection with histopathological evaluation is the most effective diagnostic and therapeutic procedure.