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1. SPLENIC ANATOMY - spleen is the largest lymphoid tissue mass in the body; it mea sures 7 to 13 cm in length and weighs up to 250 mg. The spleen develops from mesenchymal cells in the dorsal mesogastrium during week 5 of embryogenesis. . Anatomically, it comprises of two surfaces: the diaphragmatic surface and visceral surface. The diaphragmatic surface is roofed by the diaphragm, separating it from the pleura. . The spleen’s visceral sur face is in close proximity to the greater curvature of the stomach, splenic flexure of the colon, apex of the left kidney, and tail of the pancreas .

2. Functions of the spleen ● Immune ● Filter function ● Pitting ● Reservoir ● Cytopoiesis s

3. Indications for splenectomy Trauma ● Accidental ● Iatrogenic Oncological ● Part of en bloc resection ● Diagnostic ● Therapeutic Haematological ● Spherocytosis ● Purpura (ITP) ● Hypersplenism Portal hypertension ● Variceal surgery

4. Postsplenectomy septicaemia - may result from S. pneumo niae , Neisseria meningitides, Haemophilus infuenzae or Escherichia coli. Long-term surveillance programmes have suggested that the risk of pneumonia, meningitis and major sepsis following splenectomy is increased threefold. However, the risk is greater in the young patient , in splenectomised patients treated with chemoradiotherapy and in patients who have undergone splenectomy for thalassaemia, sickle cell disease and autoimmune anaemia or thrombocytopenia.

5. OPSI is typically caused by polysaccharide encapsulated organisms, such as S. pneumoniae, N. meningitidis, and H. influenzae with S. pneumoniae estimated to be responsible for between 50% and 90% of cases . Clinical presentation usually begins with flue-like symptoms characterized by fever, rigors, chills, and other nonspecific symp toms, including sore throat, malaise, myalgias, diarrhea, and vom iting . Overwhelming- postsplenectomy infection – associated risk factors. • Young age • Thalassemia major (8.2%) • Sick cell anemia (7.3%) • Idiopathic thrombocytopenia (2.1%) • Lymphoma • Immunosuppressio Overwhelming postsplenectomy infection[ OPSI ] is the most common fatal late complication of splenectomy. Infection may occur at any time after splenectomy.

6. Splenectomy ● Remember preoperative immunisation ● Prophylactic antibiotics in children and immune compromised adults ● Opportunistic postsplenectomy infection is a real clinical danger ● Splenic conservation should be considered