Keywords : Lymphoid organ , Splenic Notch , Splenic Fissure , Variation

During our dissection classes, we observed a lobulated spleen with multiple hila and fissures. The spleen presented 4 hila and 5 deep fissures. The hila were seen on the visceral surface. The fissures extended into the substance of the spleen from superior border, inferior border and the visceral surface. Because of these fissures, the spleen appeared to be lobulated, having seven distinct lobes/lobules. Knowledge of this variation could be useful to the radiologists and surgeons. [table/Fig-1]: Photograph of the visceral surface of the spleen. (F1, F2, F3, F4 and F5 fissures; H1, H2, H3 and H4, Hila; L1, L2, L3, L4, L5, L6 and L7, lobes) [table/Fig-2]: Diaphragmatic surface of the spleen. Fissures F1, F2 and F5 can be seen extending on to the surface. L1, L2, L3, L6 and L7, lobes can also be seen [table/Fig-3]: The diaphragmatic surface of the spleen. Fissures F1, F2 and F3 can be seen. Note the extension of the peritoneum into the depth of the fissures. L1, L2, L3, L6 and L7, lobes can also be seen [table/Fig-4]: Inferior view of the spleen showing the deepest fissure (F5). Two of the lobes (L6 and L7) can also be seen Satheesha B. Nayak et al., Lobulated spleen www.jcdr.net Journal of Clinical and Diagnostic Research. 2014 Sep, Vol-8(9): AD01-AD02 2 embryological reason for having notches on the superior border. The foetal spleen is lobulated but the lobulation disappears by birth. However, it may persist along the medial part of the spleen. Rarely, a splenic lobule lies partially posterior to the upper pole of the left kidney and displaces it anteriorly [8].The notches on the superior border of the adult spleen are remnants of the grooves that originally separated the fetal lobules. These notches can be sharp and are occasionally as deep as 2–3cm. Occurrence of an abnormal deep fissure on the diaphragmatic surface of the spleen has been reported recently [9]. It is quite rare to have deep fissures extending to the diaphragmatic surface and happens only in 1% of cases [5]. Gandhi et al., [10] have reported the presence of six notches on the superior border of the spleen and one on the anterior pole. As discussed earlier, abnormal notches have been found on the superior border, anterior pole and inferior border but there is no report on deep notches on the intermediate border. Our case is unique in having a deep fissure cutting through the intermediate border of the spleen. Four among the five fissures were so deep as to divide the spleen incompletely into seven distinct lobes/lobules. To the best of our knowledge, this is the first report on such a lobulation of the spleen. Presence of abnormal fissures and lobes might lead to erroneous diagnosis. Since the spleen is closely related to the left kidney and suprarenal glands, abnormal fissures and lobes of spleen might confuse the radiologists in interpretation of radiological findings especially in the blunt trauma of the upper abdomen. Smidt [11] has reported the presence of a congenital fissure mimicking splenic hematoma. Abnormal lobulation as reported here might cause misinterpretations as a mass originating from the kidney by the radiologists [12,13]. There are reports on variant branching patterns of splenic artery and point of their entry into the spleen [14-16] but reports on presence of multiple hila are lacking. In traumatic laceration of the spleen, the surgeon needs to ligate the splenic artery and remove the spleen. Presence of many hila, each containing a branch of splenic artery may lead to sparing any one of the branches without a ligature. This might lead to postoperative bleeding. 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[18] Suzuki K, Itano O, Oshima G, Osaku M, Asanuma F, Kitagawa Y. Modified Laparoscopic Splenic Vessel-Preserving Distal Pancreatectomy: Matador Assistance and Peel-Away Technique. World J Surg. 2013; 4. [Epub ahead of print]. ParticularS oF coNtriButorS: 1. Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Karnataka, India. 2. Associate Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Karnataka, India. 3. Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Karnataka, India. 4. Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Karnataka, India. 5. Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Karnataka, India. NaMe, addreSS, e-Mail id oF the correSPoNdiNg author: Dr. Satheesha Nayak B, Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University, Madav Nagar, Manipal, Karnataka, India. Phone: +91 82