splenic hilum

splenic hilum

[TA]
a fissure on the gastric surface of the spleen, giving passage to the splenic vessels and nerves.
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Patient was immediately shifted to radiology department for ultra sound abdomen which suggest large mass at splenic hilum reaching upto descending colon.
When performing distal pancreatectomy, the spleen is generally removed for easy accessibility, because of its anatomical closeness to the distal pancreas, and for ensuring extensive resection of lymph nodes located along the splenic artery and the splenic hilum. However, a growing concern about the immunological role of the spleen, in conjunction with an inclination toward healthy organ preservation, has led surgeons to avoid splenectomy at some stages during pancreatectomy for benign and low-grade malignant tumors [3].
Angiogram performed from the splenic artery confirmed the presence of an active haemorrhage from an aberrant artery which extended from the splenic hilum down to the right iliac fossa (Figure 1(c)).
Any possible bleeding from minor arterial branches of the splenic artery at the level of the splenic hilum is easily manageable because the, already mobile, pancreatic tail is further more mobilized away from the splenic hilum [12].
The MRI (magnetic resonance imaging) performed after re-admission to the Clinic two months later showed loss of pancreatic parenchyma and discontinuity of the pancreatic duct at proximal 1/3 tail of the pancreas, along with a 7-cm cyst in the splenic hilum [Fig.1].
The observed tortuosity was due to a growing difference between the arterial length and the distance from its origin and the splenic hilum (1).
Computed tomography angiography of our patient revealed splenic artery occlusion, tortuous vascular structures in the gastric fundus, and extension of these vascular structures to the splenic hilum. In our case, UGIB was considered to result from collateral arteries.
There are several possibilities which might explain that subcapsular splenic hematoma gradually disappeared after splenic artery embolization and percutaneous drainage of the large pancreatic pseudocysts: (1) splenic artery embolism reduces the blood supply of spleen, and spleen subcapsular bleeding stopped; (2) after adequate percutaneous drainage of the large pancreatic pseudocyst, the pressure of splenic hilum decreased and the return of splenic vein increased which accelerated the absorption of hematoma; (3) there was the common channel between subcapsular splenic hematoma and pancreatic pseudocyst, so subcapsular splenic hematoma was also being drained while draining the pancreatic pseudocyst.
A growing difference between the length of the vessel and the distance between its origin and the splenic hilum gives rise to tortuosity.
Splenic length, thickness, width and volume were obtained as follows: splenic length was defined as the maximum distance between the dome of the spleen and tip of the spleen on a longitudinal section in the sagittal plane) (SL), splenic width was defined as the maximum distance between the medial and lateral borders of the spleen (it was measured in a plane perpendicular to the length) (SW); splenic thickness was defined as the distance between the inner and outer surface (it was measured at the level of the splenic hilum on a transverse section) (ST) and splenic volume was calculated with the following standard elipsoid formula as; 0.524 x width x length x thickness.
Numerous gastric varices, porta hepatis and splenic hilum collaterals were noted.