International surgical boards

2022-02-23 21:39:36 Open / Comment

2022-02-23 21:37:34 Open / Comment

2022-02-23 21:35:01 Splenic artery aneurysm

This is estimated to occur in up to 1% of postmortem examinations.

They are twice as common in females, and about 50% of cases of ruptured aneurysm occur in those younger than 45 years.

The aneurysm may be discovered incidentally on a plain radiograph showing calcification in the wall of the aneurysm, in which case operation is advised for the young and fit, and observation is advised for elderly unfit patient with calcified aneurysm as risk of rupture is less in such circumstance and risk of surgery is greater.

25% of cases of ruptured splenic aneurysm occur in pregnant females usually in 3rd trimester or at time of labour, rupture is usually unsuspected and difficult to recognise.

Clinically it is unlikely to be palpable, a bruit may be heard, the treatment of choice is splenectomy with removal of diseased artery, in most cases there is just a single aneurysm involving the main trunk.

Above fig is CT scan showing a splenic artery aneurysm (arrow) Open / Comment

2022-02-23 20:08:22 Open / Comment

2022-02-23 19:31:39 Open / Comment

2022-02-23 18:53:12 Splenunculi

The term splenunculus describes a single or multiple accessory spleens.

This is a common congenital anomaly found in 10% of the population, in 50% of cases they occur near the hilum of spleen in relation to splenic vessels.

In 30% of cases they may be found behind the tail of the pancreas, and in the remainder they are located at the mesocolon or splenic ligaments.

Their significance is that if splenectomy is performed to cure a particular pathology such as chronic hemolysis or idiopathic thrombocytopenic purpura, the original pathology may persist because these splenunculi act as a continued source of RBC or platelet destruction.

Above figure is an intraoperative view of a splenunculus at the mesentry (arrow). Open / Comment

2022-02-23 18:03:41 Circulation of the spleen

Blood enters the spleen via the splenic artery, a branch of the coeliac axis, initially it divide into a superior and inferior branches which furthur subdivide into segmental and eventually central arteries.

These central arteries enter into the white pulp, which is a condensation of lymphatic nodules surrounding the artery, blood passes through these nodules where foreign antigens are recognized and antibodies are produced.

After blood exists the white pulp, it will enter into very thin cords, known as cords of bilroth (black arrows) which has slits that size about 2 microns, RBC is about 8 microns, it has to deform to pass via these tiny holes.

After RBC's pass via the cords they will enter directly into splenic sinuses which are drained by splenic venules, together the cords and sinuses comprises the red pulp.

The spleen recieve about 300 mL of blood per min, 90% of which pass through the pathway described above, 10% bypass it by AV connections. Open / Comment

2022-02-23 17:18:57 Open / Comment

2022-02-14 22:24:42 Open / Comment

2022-02-13 15:14:24 Open / Comment