Lies in left side of lesser sac. Entirely coated by peritoneum.
Splenic artery runs in lienorenal ligament past the tail of the pancreas.
Splenic vein runs parallel to artery, but inferior and behind the pancreas. IMV drains into splenic vein behind body of pancreas.
Attachments:
- Lienorenal ligament
- Gastrosplenic ligament – connects to greater curve of stomach
- Each of these have 2 layers of peritoneum, one each from the lesser sac
- Phrenicocolic ligament at splenic flexure
Bleeding spleen:
- Direct pressure with raytec
- Haemostasis agents – Floseal, Tachosil
- Splenectomy
- Direct control of splenic vessels with hand – after freeing left sided leaf of lienorenal ligament – avoid immediate clamp/staple as may injure tail of pancreas
- Once hilum controlled with hand, improve exposure and ensure tail of pancreas out of the way before taking hilum with stapler
- There may be short gastric branches and left gastroepiploic branches in the gastrosplenic ligament
Pancreas tear:
- Direct compression and then may be best left alone if no bleeding and small – sutures may compound the injury
- If transection – any visible duct structure should be oversewn and remainder of parenchyma oversewn or stapled
- Risk + of pancreatic leak – must leave drain(s)
- Enzymes cause inflammation – will usually seal with drainage but may take a long time