Chapter 70: The Spleen

A 18-year-old woman underwent laparoscopic splenectomy for idiopathic thrombocytopenic purpura (ITP) after failed medical treatment. Six months after surgery, there was relapse with similar symptoms and blood parameters as before surgery. The most likely cause of this recurrence of symptoms would be attributed to …

A 26-year-old man was brought to the Accident and Emergency Department in an ambulance with a history of a road traffic accident sustained due to a motorcycle crash on the motorway. At presentation, which was 1 hour after injury, the patient had a pulse of 110 per minute and a systolic blood pressure of 100 mmHg. Resuscitation was initiated and a FAST scan was conducted that was positive. A contrast-enhanced computed tomography (CECT) scan was ordered by the surgical registrar after confirming haemodynamic stability. This was reported as a grade 2 injury with a subcapsular haematoma over 20% of the surface area of the spleen, a 2-cm intraparenchymal haematoma and a parenchymal laceration of 2 cm with 100 ml of intraperitoneal fluid with no other organ injury. The most likely management for this patient is …

A 30-year-old man underwent an elective open splenectomy for tropical splenomegaly with hypersplenism. In the postoperative period, the patient presented 2 weeks after surgery with a high-grade fever with chills, cough and breathlessness. At presentation, the patient was found to be in shock with warm peripheries. The most likely diagnosis for this condition is …

All of the following are appropriate in the management of a 10-year-old boy diagnosed with idiopathic thrombocytopenic purpura (ITP) who is planned for elective splenectomy except …

Which of the following structures is ligated FIRST during elective splenectomy in order to reduce intraoperative bleeding?