Research Title

Anatomy of Spleen

Student name: Omar Mohamed Bakr Ali

ID number: 2200

Grade: 2nd year medical student

Department: Anatomy

Block: Hematology & Lymphatic System

 Anatomy of the spleen

Introduction:
Located in the abdomen, directly beneath the diaphragm, and connected to the stomach, the
spleen is the body’s largest filter of the blood. In essence, the spleen is organized as a tree of
branching arterial vessels, in which the smaller arterioles end in a venous sinusoidal system.
Prenatally, the spleen is a hematopoietic (blood-forming) organ, but after birth, it is involved
primarily in identifying, removing, and destroying expended red blood cells (RBCs) and
broken-down platelets and in recycling iron and globin. The spleen serves as a blood reservoir,
storing RBCs and platelets, and, to a limited degree, can provide a sort of “self-transfusion” as a
response to the stress imposed by hemorrhage. In spite of its size and the many useful and
important functions it provides, it is not a vital organ (not necessary to sustain life) [1].
The spleen combines the innate and adaptive immune system in a unique way. The structure of
the spleen permits it to remove older RBCs from the circulation and leads to removal of blood-
borne microorganisms and cellular debris. This function, in combination with a highly ordered
lymphoid compartment, makes the spleen the most important organ for antibacterial and
antifungal immune reactivity [2].
In this review, we will illustrate the anatomic features and relations of the spleen, and its
clinical importance.

Structure & function:

The spleen is an ovoid, usually purplish, pulpy mass about the size and shape of one’s fist. It is
relatively delicate and considered the most vulnerable abdominal organ. The spleen is located in
the superolateral part of the left upper quadrant (LUQ), or hypochondrium of the abdomen,
where it enjoys protection of the inferior thoracic cage. The spleen is the largest of the
lymphatic organs in the human body. It is important to note, that while the spleen does have a
wide range of functions, it is not a vital organ. The spleen is variable in size, shape and weight.
Its length, width and thickness are approximately 12, 7 and 3 cm respectively. Its weight, on
average, is 150g (figure 1) [3].
Fig 1: The visceral surface of the spleen. Mahadevan V. (2019) Anatomy of the pancreas and spleen, Surgery (Oxford).

The spleen possesses a thin capsule, outside which it is enveloped almost completely in visceral
peritoneum, and has a moderate degree of mobility. The spleen consists of 2 different tissue
types, termed white pulp and red pulp, with each tissue type serving unique functions. The
white and red pulp regions are separated by a border known as the marginal zone which
functions as a filter, filtering pathogens out of the blood and into the white pulp [3].
The white pulp (lymphoid region) is composed of periarteriolar lymphoid sheaths (PALS) and
lymphatic nodules. The white pulp tissue is involved with the production and maturity of
WBCs, particularly lymphocytes (types B and T) and thereby the production of antibodies. The
white pulp is organized as lymphoid sheaths, with T- and B-cell compartments, around the
branching arterial vessels, so it closely resembles the structure of a lymph node [4].
The correct organization and maintenance of the white pulp is controlled by specific
chemokines that attract T and B cells to their respective domains, thereby establishing specific
zones within the white pulp. In the T-cell zone (also known as the periarteriolar lymphoid
sheath, PALS), T cells interact with DCs and passing B cells, whereas in the B-cell follicles
(also known as the B-cell zones), clonal expansion of activated B cells can take place, which
leads to isotype switching and somatic hypermutation [5].
The red pulp is composed of splenic sinusoids (wide blood vessels) and cords/threads of
connective tissue. The red pulp tissue is involved more so with the filtering aspect of the blood.
The red pulp removes old, damaged, and/or useless red blood cells. Contained within the red
pulp are also WBCs, particularly phagocytes (macrophages in particular) which destroy
microorganisms such as viruses, bacteria, and fungi [6]. The red pulp also acts as a storage area
for WBCs and platelets, which are typically released to injury sites to aid in healing and
inflammation regulation or to assist in blood loss compensation.
Erythrophagocytosis also is important for the turnover of erythrocytes, and recycling of iron is
an important task of splenic macrophages, in conjunction with those of the liver. Erythrocytes
are hydrolyzed in the phagolysosome of macrophages, from which heme is released after the
proteolytic degradation of hemoglobin. Heme is then further catabolized into biliverdin, carbon
monoxide and ferrous iron (Fe2+), after which the iron is either released from cells or stored
[7].

Fig 2: Anatomical localization of the structures that form the cut section of spleen. Kenhub Anatomy

Surface anatomy and anatomic relations:

The spleen is a mobile organ although it normally does not descend inferior to the costal (rib)
region; it rests on the left colic flexure. It is associated posteriorly with the left 9th–11th ribs (its
long axis is roughly parallel to the 10th rib) and separated from them by the diaphragm and the
costodiaphragmatic recess; the cleft-like extension of the pleural cavity between the diaphragm
and the lower part of the thoracic cage [4]. The diaphragmatic surface of the spleen is convexly
curved to fit the concavity of the diaphragm and curved bodies of the adjacent ribs. The close
relationship of the spleen to the ribs that normally protect it can be a detrimental one in the
presence of rib fractures. The anterior and superior borders of the spleen are sharp and often
notched, whereas its posterior (medial) end and inferior border are rounded. The relations of the
spleen are as follows [1]:
 Anteriorly, the stomach.
 Posteriorly, the left part of the diaphragm, which separates it from the pleura, lung, and
ribs 9–11.
 Inferiorly, the left colic flexure.
 Medially, the left kidney.

Embryogenesis:
Mesenchymal cells are the source from which the spleen is derived from, which are located
between the tiers of the dorsal mesogastrium as early as the fifth and sixth weeks of fetal
development. The characteristic shape of the spleen is something which occurs early in the fetal
period. The rotation of the stomach during embryonic development causes the left
mesogastrium surface fusion with the peritoneum above the left kidney and the resultant dorsal
attachment of the lienorenal ligament. The yolk sac wall and near dorsal aorta are the sources of
the cells needed for the hemopoietic function of the spleen. By the second trimester, the spleen
is capable of both RBC and WBC generation [8] (figure 3).
Some congenital anomalies of the spleen are common, such as splenic lobulation and accessory
spleen, while other conditions are rare, such as wandering spleen and polysplenia.
Splenogonadal fusion is also a rare developmental anomaly, resulting from abnormal fusion of
the splenic and gonadal primordia during prenatal development [9].
Fig 3: Macroscopic view of the dorsal mesogastrium showing the presence of the spleen or its primordium at Carnegie
stages 14, 16, 20, and 23. *, Spleen (primordium); St, stomach; red arrow, segmentation by the folds; black arrow,
intrahepatic folds. Endo, A., Ueno, S., Yamada, S., Uwabe, C. and Takakuwa, T. (2015), Morphogenesis of the Spleen
During the Human Embryonic Period.

Blood supply:
The spleen derives its arterial supply solely from the splenic artery, the largest branch of the
celiac trunk, which runs along the upper border of the body and tail of the pancreas and enters
the splenorenal ligament accompanied by the splenic vein and often by the pancreatic tail.
Either at the splenic hilum or more proximally within the splenorenal ligament, the splenic
artery bifurcates into inferior and superior divisions [7].
Just before entering the splenic hilum, either the main trunk of the splenic artery or one or other
of the terminal divisions of the splenic artery gives rise to the short gastric arteries and the left
gastroepiploic artery. These arteries, accompanied by veins, reach the greater curvature of the
stomach by running within the gastrosplenic ligament. The short gastric arteries travel
proximally to the gastric fundus, while the left gastroepiploic artery travels distally, along the
greater curvature, to meet the right gastroepiploic artery [1,3].
Lymphatic vessels of the spleen are solely efferent lymphatic vessels, with the spleen acting
analogously to a large lymph node supplying lymph material to neighboring nodes such as the
pancreaticosplenic lymph nodes [10].
Innervation:
Sympathetic innervation of the spleen comes from the coeliac plexus, and are distributed mainly
along branches of the splenic artery and are vasomotor in function [1,11].

Clinical significance:
Understanding the spleen and issues related to the spleen is of great clinical significance
because despite it not being a vital organ, issues thereof can potentially be life-threatening. The
spleen is one of the abdominal organs with the greatest incidence of injury, with rupture being a
big concern possibly justifying splenectomy to avoid excessive hemorrhaging into the
peritoneal cavity. A rupture is characterized by a break of the capsule encasing the spleen and
disruption of the parenchyma beneath. Such rupture may be caused by blunt force or
penetrating trauma [12].

Also, spleen may also become enlarged (splenomegaly) for a variety of reasons. Some of these
reasons include viral or bacterial infection, vein blockages and related increased venous
pressure, cancer, and circulations issues relate to abnormal cells. The spleen does not normally
extend inferior to the left costal margin; thus, it is seldom palpable through the anterolateral
abdominal wall unless it is enlarged. When it is hardened and enlarged to approximately three
times its normal size, it moves inferior to the left costal margin, and its superior (notched)
border lies inferomedially. The notched border is helpful when palpating an enlarged spleen
because, when the person takes a deep breath, the notches can often be palpated [1, 12].

References:
1. Moore, K. L., & Dalley, A. F. (1999). Clinically oriented anatomy. Philadelphia: Lippincott Williams & Wilkins.
2. Mahadevan V. (2019) Anatomy of the pancreas and spleen, Surgery (Oxford), Volume 37, Issue 6, Pages 297-
301.
3. Chaudhry SR, Luskin V, Panuganti KK. Anatomy, Abdomen and Pelvis, Spleen. [Updated 2020 Apr 6].
4. Mebius, R. E., & Kraal, G. (2005). Structure and function of the spleen. Nature reviews. Immunology, 5(8), 606–
616.
5. Kraal, G. Cells in the marginal zone of the spleen. Int. Rev. Cytol. 132, 31–73 (1992).
6. Steiniger, B. & Barth, P. Microanatomy and function of the spleen. Adv. Anat. Embryol. Cell Biol. 151, III–IX;
1–101 (2000).
7. Lung K, Lui F. Anatomy, Abdomen and Pelvis, Arteries. StatPearls. StatPearls Publishing; Treasure Island (FL):
Dec 6, 2018.
8. Endo, A., Ueno, S., Yamada, S., Uwabe, C. and Takakuwa, T. (2015), Morphogenesis of the Spleen During the
Human Embryonic Period. Anat. Rec., 298: 820-826.
9. Varga, I., Galfiova, P., Adamkov, M., Danisovic, L., Polak, S., Kubikova, E., & Galbavy, S. (2009). Congenital
anomalies of the spleen from an embryological point of view. Medical science monitor: international medical
journal of experimental and clinical research, 15(12), RA269–RA276.
10. Flo, T. H. et al. Lipocalin 2 mediates an innate immune response to bacterial infection by sequestrating iron.
Nature 432, 917–921 (2004).
11. Cinamon, G. et al. Sphingosine 1-phosphate receptor 1 promotes B cell localization in the splenic marginal zone.
Nature Immunol. 5, 713–720 (2004).
12. Steiniger BS, Wilhelmi V, Berthold M, Guthe M, Lobachev O. Locating human splenic capillary sheaths in
virtual reality. Sci Rep. 2018 Oct 24;8(1):15720.