[The ligament system of the spleen and its significance for surgical interventions]

The anatomy of the splenic ligaments was examined in twenty cadavars. Histologic sections were taken from ten. In one of these twenty cases the entire ligamentous structure was studied by serial sections using a polarizing light microscope. There are four principal ligaments of the spleen: the gastrosplenic ligament, the colicosplenic ligament, the phrenocolic ligament and the phrenosplenic (splenorenal) ligament. There are two portions to the gastrosplenic ligament. In the upper portion where the spleen is very close to the stomach, the collagen fibers appear more dense. The term splenorenal ligament is vague. This is because there are three structures between the spleen and the kidney besides the peritoneal layer: collagenous tissue with fat (pararenal fat), the prerenal fascia and a fat capsule (perirenal fat). The vascular anatomy is of interest. Running through the gastrosplenic ligament are small branches from the short gastric and left gastroomental vessels. The colicosplenic ligament receives little branches from the left gastroomentalic vessels and the lower pole vessels. The other ligaments have mainly venous vascularisation which can develop into a collateral network within splenomegaly. The direction of the collagen fibers in the splenic ligaments is important. In all the ligaments most of the fibers come from two directions: laterocranial to mediocaudal and mediocranial to laterocaudal. Splenic capsular tears are a recognized complication of upper abdominal surgery. This is because traction in the mediocaudal direction during gastric and colon surgery and in the mediocranial direction during gastric surgery is oriented in the same direction as the collagen fibers in the splenic ligaments and thus tears the splenic capsule.