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Chapter 34: Spleen

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Which of the following is NOT a location where accessory spleens can be found?

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A. Gastrocolic ligament

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B. Gerota’s fascia

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C. Large bowel mesentery

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D. Broad ligament

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Answer: B

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The most common anomaly of splenic embryology is the accessory spleen. Present in up to 20% of the population, one or more accessory spleen(s) may occur in up to 30% of patients with hematologic disease. Over 80% of accessory spleens are found in the region of the splenic hilum and vascular pedicle. Other locations for accessory spleens in descending order of frequency are: the gastrocolic ligament, the tail of the pancreas, the greater omentum, the greater curve of the stomach, the splenocolic ligament, the small and large bowel mesentery, the left broad ligament in women, and the left spermatic cord in men. (See Schwartz 10th ed., p. 1424.)

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Which of the following splenic ligaments is NOT an avascular plane?

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A. Gastrosplenic

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B. Splenocolic

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C. Phrenosplenic

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D. Splenorenal

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Answer: A

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Of particular clinical relevance, the spleen is suspended in position by several ligaments and peritoneal folds to the colon (splenocolic ligament); the stomach (gastrosplenic ligament); the diaphragm (phrenosplenic ligament); the kidney, the adrenal gland, and the tail of the pancreas (splenorenal ligament) (Fig. 34-1). Whereas the gastrosplenic ligament contains the short gastric vessels, the remaining ligaments are usually avascular, with rare exceptions, such as in a patient with portal hypertension. The relationship of the pancreas to the spleen also has important clinical implications. In cadaveric anatomic series, the tail of the pancreas has been demonstrated to lie within 1 cm of the splenic hilum 75% of the time and to actually abut the spleen in 30% of patients. (See Schwartz 10th ed., Figure 34-2, p. 1425.)

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Image not available.

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Fig. 34-1. Suspensory ligaments of the spleen. (Data from Poulin EC, Thibault C. The anatomical basis for laparoscopic splenectomy. Can J Surg 36:484;1993.)

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All of the following are functions of the spleen EXCEPT

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A. Clearance of damaged or aged red blood cells (RBCs) from the blood.

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B. Extramedullary site for hematopoiesis and recycling iron.

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C. Initiation of adaptive immune response from filtration of lymph.

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D. Clearance of encapsulated bacteria from the bloodstream.

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