Illustrated Encyclopedia of Human Anatomic Variation: Opus IV: Organ Systems: Digestive System and Spleen

Spleen

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD
Peer Review Status: Internally Peer Reviewed

Notches on the anterior, posterior, and inferior borders, and fissures on the diaphragmatic surface of the spleen have been reported. The anterior border was free of notches in eight of 113 specimens examined; most commonly there were two notches, but in one case there was seven. Notches on the posterior border occured in 32% of cases and on the inferior border in 8%.

The fissures on the diaphragmatic surface do not appear to represent the persistence of a primitive lobulation.

When the spleen is absent, the splenic artery terminates in the pancreas.

Small, detached, roundish nodules are occasionally found in the neighborhood of the spleen and are similar to it in substance. These are commonly called accessory or supplementary spleens (splenculi or lienculi). In one study (Curtis and Movitz), accessory spleens were found at 56 operations. Fifty-four percent were found in the hilar region of the spleen, 25% were associated with the splenic vascular pedicle, 6% with the tail of the pancreas, 2% with the splenocolic ligament, 12% with the greater omentum, 0.5 % with the mesentery, and 0.5% with the left ovary. One or two most commonly occur, but up to 23 have been reported. The small masses vary from the size of a pea (0.5cm) to that of a walnut (3.75cm).

They may be found along the borders of the spleen, especially its anterior aspect, and in the hilum. They may also occur in the scrotum, greater omentum, transverse mesocolon, and gastrolienal ligament, behind the left lobe of the liver, near the pancreas, and embedded in the connective tissue surrounding the splenic vessels. They occur most frequently however, in the tail of the pancreas (about one of every six cases of accessory spleen). The incidence of accessory spleen is about 10% or more.

Heterotopic islands of pancreatic tissue have been found in the spleen.

Human adult spleens have been reported to weigh between 80 and 300grams. Because of their physiologic activity, no two spleens are structurally alike.

Positions of accessory spleens found at fifty-six operations

Accessory Spleen

Doubled Spleen

Accessory Spleen

References

Abu-Hijleh, M.F. (1993) Multiple accessory spleens: Case report and literature review. Clinical Anatomy 6:232-239.

Albrecht, A. (1896) Ein Fall von sehr zahlreichen, iffier das ganze Peritoneum versprengten Nebenmitzen. Beitr. z. Path. Anat. 20:513-527.

Arnold, J. (1868) Ein Fall von Cor trioculare biatrium, Communication der Lungenvenen mit der Pfortader und Mangel der Milz. Arch. Pathol. Anat. Physiol. Klin. Med. 42:449-472.

Barbosa, J.J. de C., Dockerty, M.B. and J.M. Waugh. (1946) Pancreatic heterotopia: Review of literature and report of 41 authenticated surgical cases, of which 25 were clinically significant. Surg., Gynecol. Obstet. 82:527-542.

Bennett-Jones, M.J. and C.A. St. Hill. (1952) Accessory spleen in the scrotum. Brit. J. Surg. 40:259-262.

Boggs, J.D. and W. Reed. (1953) Congenital absence of the spleen. Q. Bull. Northwestern University Medical School 27:289-293.

Cunningham, D.J. (1895) The form of the spleen and the kidneys. J. Anat. Physiol. 29:501-517.

Curtis, G.M. and D. Movitz. (1946) The surgical significance of the accessory spleen. Ann. Surg. 123:276-298.

Emmet, J.M. and M.L. Drefuss. (195 1) Accessory spleen in scrotum. Ann. Surgery 117:754-759.

Gruber, W. (1885) Mangel der linken Lunge bei Vorkommen einer Nebenleber und dreier Nebenmilzen. Arch. f. Path. Anat. u. Physiol. u. f. Klin. Med. 102:11-12.

Haberer, H. (1901) Lien succenturiatus und Lien accessorius. Arch. f. Anat. u. Physiol. u. Entwickelungsgeschichte. 1901:47-56.

Halbert, B. and W.L. Eaton (1951) Accessory spleen: A pilot study of 600 necropsies. Anat. Rec. 109:371.

Halff, J. (1904) Ein Fall von situs inversus des Magens, des Duodenums und der Milz bei einem 63jährigen, weiblichen Individuum. Münchener Med. Wochenschr. 2:2287-2289.

Halpert, B. and W.L. Eaton. (1951) Accessory spleens: A pilot study of 600 necropsies. Anat. Rec. 109:371.

Halpert, B. and F. Györkey. (1959) Lesions observed in the accessory spleens of 311 patients. Am. J. Clin. Pathol. 32:165-168.

Halpert, B. and F. Györkey. (1959) Accessory spleens: A survey of 3000 necropsies. Anat. Rec. 133:389.

Hamrick, R.A. and J.D. Bush. (1942) Autoplastic transplantation of splenic tissue in man, following traumatic rupture of the spleen. Ann. Surg. 115:84-92.

Hodenpyl, E. (1898) A case of apparent absence of the spleen, with general compensatory lymphatic hyperplasia. Med. Rec. 54:695-698.

Hu, C.H. (1929) Congenital malformation with anomalous insertion of pulmonary veins, absence of spleen, situs inversus of abdominal viscera and other developmental errors. Am. J. Path. 5:389-396.

Jarcho, S. and D.H. Anderson. (1939) Traumatic autotransplantation of splenic tissue. Am. J. Pathol. 15:527-546.

Krueter, -. (1,920) Experimentelle Untersuchungen tiber die Entehung der sogenannten Nebenmilzen, Insbesondere nach milzverletzungen. Beitr. z. Klin. Chir. 118:76-94.

Krumbhaar, E.B. and S.W. Lippincott. (1939) Postmortem weight of "normal" human spleen of different ages. Am. J. Med. Sci. 197:344-358.

McCormick, W.F. and M. Kashgarian. (1965) The weight of the adult human spleen. Am. J. Clin. Pathol. 43:332-333.

McLaughlin, Jr. C.W., Sharpe, J.C. and R. Cunningham. (1941) Surgery of the spleen in hemolytic jaundice. Internat. Clin. 4:108-125.

Michels, N.A. (1942) The variational anatomy of the spleen and splenic artery. Am. J. Anat. 70:21-72.

Minkes, R.K., Lagzdins, M. and J.C. Langer. (2000) Laparoscopic versus open splenectomy in children. J. Pediatric Surgery 35(5):699-701.

Morrison, M., Lederer, M. and W.Z. Fradkin. (1928) Accessory spleen: Their significance in essential thrombocytopenic purpura hemorrhagica. Am. J. Med. Sci. 176:672-681.

Murphy, J.W. and W.A. Mitchell. (1957) Congenital absence of the spleen. Pediatrics 20:253-256.

Olken, H.G. (1945) Accessory splenic tissue within scrotum. Am. J. Pathol. 21:81-85.

Paul, M. (1937) Accessory spleens. Lancet 2:74-77.

Perla, D. (1936) The regeneration of autoplastic splenic transplants. Am. J. Pathol. 12:665-675.

Polhemus, D.W. and W.B. Schafer. (1952) Congenital absence of the spleen: Syndrome with atrioventricularis communis and situs inversus. Pediatrics 9:696-718.

Rhodes, A.J. and A. Grunberg. (1942) Case of abdominal lymphadenoma with transposition of viscera and nine accessory spleens. Edinburgh Med. J. 49:29-33.

Robert, H.L.F. (1842) Hemmungsbildung des Magens, Mangel der Milz und des Netzes. Arch. Anat. Physiol. Wissen Med. 1842:57-60.

Roettig, L.C., Nussbaum, W.D. and G.M. Curtis. (1943) Traumatic rupture of the spleen. Am. J. Surg. 59:292-319.

Schilling, K. (1907) über einen Fall von multiplen Nebenmilzen. Virchow's Arch. f. Pathol. Anat. u. Physiol. u. f. Klin. Med. 188:65-87.

Settle, E.B. (1940) The surgical importance of accessory spleen with report of two cases. Am. J. Surg. 50:22-26.

Shaw, A.F.B. and A. Shafi. (1937) Traumatic autoplastic transplantation of splenic tissue in man: With observations on late results of splenectomy in six cases. J. Pathol. Bact. 45:215-235.

Shepard, R.K. (1903) The form of the human spleen. J. Anat. Physiol. 37:50-69.

Sneath, W.A. (1913) An apparent third testicle consisting of a scrotal spleen. J. Anat. Physiol. 47:340-342.

Sternberg, C. (1903) Ein Fall von Agenesie der Milz. Arch. Pathol. Anat. Physiol. Klin. Med. 173:571-575.

Stiris, M.G. (1980) Accessory spleen versus left adrenal tumor: Computed tomographic and abdominal angiographic evaluation. J. Comp. Assist. Tomograph. 4(4):543-544.

Stubenrauch, -., von. (1920) Verlust und Regeneration de milz beim Menschen. Beitr. z. Klin. Chir. 118:285-305.

Vaughn, J.M. (1937) Treatment of thrombocytopenic purpura. Brit. Med. J. 2:842-845.

Watson, C.J. and W.W. Moir, Jr. (1941) Recurrence of thrombocytopenic purpura after splenectomy in a case of accessory spleen. Internal. Clin. 4:221-230.

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