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34 - Splenectomy

from Part IV - Abdomen

Published online by Cambridge University Press:  08 January 2010

By
Jennifer H. Aldrint  and
Henry E. Rice
Edited by
Mark D. Stringer ,
Keith T. Oldham  and
Pierre D. E. Mouriquand
Jennifer H. Aldrint
Affiliation:
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Henry E. Rice
Affiliation:
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Introduction

The first attempt to define the role of the spleen was made by Hippocrates around 400BC, who taught that the spleen “drew the watery part of food from the stomach.” Aristotle believed that the spleen had no function, and the ancient Greeks felt that the weight of the spleen hindered a man's athletic abilities and therefore applied hot irons to reduce its size. Although many believed the spleen played a role in “cleansing the blood and spirit from unclear and obscuring matter,” the belief that the spleen was a non-essential organ that could be removed without adverse affects persisted until the early 1900s.

Morris and Bullock in 1919 were the first to recognize the spleen's role in infection based upon animal studies stating, “It is an observation of great antiquity that the operation of splenectomy is not followed by death … but this does not settle the problem as to whether or not a splenectomized person can weather a critical illness.” Following the landmark report by King and Shumaker in 1952 of five cases of sepsis in splenectomized infants, the association between fulminate bacterial sepsis following splenectomy has been firmly established.

Embryology and anatomy

The primordial spleen appears as a mesodermal proliferation arising from the dorsal mesogastrium during the fifth and sixth weeks of embryologic development. As the stomach rotates and the dorsal mesogastrium lengthens, the spleen is carried to the left upper quadrant of the abdomen where it fuses with the peritoneum of the posterior abdominal wall.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
 , pp. 435 - 445
Publisher: Cambridge University Press
Print publication year: 2006

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