The Spleen

Original Author: Oliver Jones
Last Updated: January 21, 2017
Revisions: 29
Fig 1.0 - The anatomical position of the spleen in the abdomen.

Fig 1.0 – The anatomical position of the spleen in the abdomen.

The spleen is an organ located in the upper left abdomen, roughly the size of a clenched fist. In the adult, the spleen functions mainly as a blood filter, removing old red blood cells. It also plays a role in the immune response.

In this article, we shall look at the anatomical position, structure and vasculature of the spleen. We shall also consider the clinical correlations of its anatomy.


Anatomical Position and Relations

The spleen in located in the upper left quadrant of the abdomen, under cover of the diaphragm and ribcage – and therefore cannot be palpated on clinical examination. It is an intraperitoneal organ, entirely surrounded by peritoneum (except at the splenic hilum).

It lies in close proximity to other structures in the abdomen:

Anterior Posterior Inferior Medial
Stomach Diaphragm

Left lung

Ribs 9-11

Left colic flexure (splenic flexure) Left kidney

Tail of the pancreas

The spleen is connected to the stomach and kidney by parts of the greater omentum – a double fold of peritoneum that originates from the stomach:

  • Gastrosplenic ligament – connects the spleen to the greater curvature of the stomach.
  • Splenorenal ligament – connects the hilum of the spleen to the left kidney. The splenic vessels and tail of the pancreas lie within this ligament
Fig 1.1 - The ligaments of the spleen. Note how the splenic vessels run within the splenorenal ligament.

Fig 1.1 – The ligaments of the spleen. Note how the splenic vessels run within the splenorenal ligament.


Structure

The spleen has a slightly oval shape. It is covered by a weak capsule that protects the organ, whilst allowing it to expand in size.

The outer surface of the spleen can be anatomically divided into two:

  • Diaphragmatic surface – in contact with diaphragm and ribcage.
  • Visceral surface – in contact with the other abdominal viscera.

It has anterior, superior, posteromedial and inferior borders. The posteromedial and inferior borders are smooth, whilst the anterior and superior borders contain notches. In enlargement of the spleen (known as splenomegaly), the superior border moves inferomedially, and its notches can be palpated.


Fig 1.2 - An overview of the venous portal system - draining into the hepatic portal vein.

Fig 1.2 – An overview of the venous portal system – draining into the hepatic portal vein.

Neurovascular Supply

The spleen is a highly vascular organ. It receives its arterial supply from the splenic artery. This vessel arises from the coeliac trunk, running laterally along the superior aspect of the pancreas, within the splenorenal ligament. As the artery reaches the spleen, it branches into five vessels – each supplying a different part of the organ.

These arterial branches do not anastomose with each other – giving rise to vascular segments of the spleen. This enables a surgeon to remove one of these segments without affecting the others (a procedure known as a subtotal splenectomy).

Venous drainage occurs through the splenic vein. It combines with the superior mesenteric vein to form the hepatic portal vein.

The nerve supply to the spleen is from the coeliac plexus.

Clinical Relevance: Rupture of the Spleen

Fig 1.3 - CT scan of a ruptured spleen.

Fig 1.3 – CT scan of a ruptured spleen.

The spleen is the abdominal organ with the highest incidence of injury. A splenic rupture occurs when there is a break in its fibroelastic capsule, disrupting the underlying parenchyma.

Rupture is caused by blunt or penetrating trauma. It is often associated with left rib fractures, with a bony fragment easily tearing the capsule.

As the spleen is a highly vascular organ, its rupture results in profuse bleeding into the peritoneal cavity. Definitive treatment is the full or partial removal of the spleen.

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Quiz

Question 1 / 5
In which quadrant of the abdomen does the spleen lie?

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Question 2 / 5
Which of the following structures lies anteriorly to the spleen?

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Question 3 / 5
Which border of the spleen has notches that can be palpated when the spleen is enlarged? (splenomegaly)

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Question 4 / 5
Which vessel provides the arterial supply to the spleen?

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Question 5 / 5
The nerve supply to the spleen is which of the following?

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