It’s HUGE! How to Handle Masses of the Liver and Spleen

Anatomy/Physiology Review: The spleen is a hemolymphatic organ that contributes to immune function, platelet synthesis, erythrocyte storage, and removal of senescent erythrocytes. A tough, muscular splenic capsule surrounds the “red pulp” (venous sinuses and mixed cellular tissue) and white pulp (nodular and diffuse lymphoid tissue). The splenic capsule is capable of significant contraction after alpha adrenergic stimulation, causing release of additional erythrocyte mass into the circulation during times of stress. The spleen lies immediately caudal to the stomach, in the superficial leaf of the greater omentum. The head of the spleen lies cranially and is closely associated with the fundus of the stomach on the left side of the abdomen, being attached by a short gastrosplenic ligament. The tail of the spleen extends caudally and to the right, although the location of this portion of the spleen can vary significantly in due its greater mobility. Arterial supply to the spleen is from the splenic artery, a branch from the celiac artery (Figure 1). Before reaching the spleen, the splenic artery sends off several arterial branches to the left lobe of the pancreas, which constitute the majority of the blood supply to that area . The splenic vein drains into the gastro-splenic vein, then into the portal vein where blood is processed before returning to the heart.