Part two - spleen

Question 1

Functions of spleen

Answer 1

Haematologic functions

• storage RBCs
• maturation RBCs
• destruction RBCs

Immunologic functions:

• produces peptides necessary for phagocytosis of encapsulated bacteria
• syntheses antibody
• reservoir for monocytes mobilised after tissue injury

Question 2

Most common indications for elective splenectomy

Answer 2

Idiopathic thrombocytopaenic purport

Haemolytic anaemias

Question 3

Laparoscopic splenectomy

Answer 3

Standard approach for majority
60-90 minutes
LoS 1-2 days

Benefits:

• less pain
• more rapid recovery
• fewer respiratory complications

Conversion:

• 0-19%
• bleeding
• difficulty mobilising due to size or adhesions
• injury to adjacent organs

Controversial in:

• large spleens
• trauma
• adequacy in removing accessory spleens in ITP

Question 4

Rate of intra-operative splenic injury during laparotomies

Answer 4

0.01%

Up to 10% splenectomies performed for iatrogenic injury