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Transcript

Description of the anatomy and histology of the spleen at the vascular and perivascular level and its involvement in its lesional presentation and evolution during blunt trauma

Student: Alexia Bichon and Anne Allarousse
Advisor: Alexandre Bellier

28/01/2022

01. Introduction

02. Goals

04. Results

05. Discussion

06. Conclusion

08. Thanks

07. Bilbiography

Index

03. Methods

Introduction

.01

1.1 General anatomical and vascularisation description



Hc : common hepatic artery, Gg : left gastric artery, Gc : short gastric arteries , S: splenic artery, PD : dorsal pancreatic artery, AMS: superior mesenteric artery

1 - phrenico-splenic ligament(lgt), 2 - phrenico-colic lgt, 3 - spleno-colic lgt, 4 - spleno-gastric lgt, 5 - reno-splenic lgt, 6 - pancreatico-splenic lgt
E : stomach, Rt : spleen, Rn : kidney, P : pancreas,
C : colon

Spleen vascularization, fixation and relationships with the other abdominal organs

- lymphoid organ, left hypochondrium
- friable texture easily torned
- held in the abdominal cavity by different ligament
- red and white pulp with different functions : hemolytic and immune


- splenic artery : terminal branch of the coeliac trunk
- colleteral branches : it end with two branches creating two lobes
- lobar artery -> segmental artery in the hilum
- Drained by trabecular veins -> splenic vein
- ONLY efferent lymphatic vessels

Introduction

.01

1.2 Spleen scanography, what is a “blush” ?

Focal hyperattenuation isodense to the main arterial vessels :


-> Active arterial extravasation within a haematoma
-> called "BLUSH"
-> embolisation if needed

Introduction

.01

1.4 Synchrotron Imaging

1- Utility


- resolution and sensitivity down to te cellular level
- high tissue contrast
- imaging whole human body in detail

2- Mecanism

- source of Xrays producted by electrons of high energy
- based on detection of attenuation or phase shift of Xrays
- lower then higher resolution
- Sequential acquisition
- Two dimensionnal -> three dimansional model

Introduction

.01

1.5 Spleen trauma

- Most frequent trauma-related injuries -> intense hemorrage

- Classification according to AAST Spleen trauma

- Hemodynamic stability + blunt splenic trauma -> nonoperative management

- Splenic blush : predictor of failure of NOM

- Absence of splenic blush on CT scane : does not exclude it !

- Angiography + angioembolization : first line intervention if hemodynamic stability + arterial blush

- Unstable patients : operative management

THERAPEUTIC DILEMMA

Introduction

.01

1.6 Hemerheology and hemostasis

HEMOSTASIS

HEMERHEOLOGY

MAJOR STEPS

- Vascular spasm
- Plug
- Activation of the coagulation factors
- Retraction of the clot
- Vascular repair
- Fibrinolysis

+

FACTORS

- Vascular factors
- Platelets
- Plasma coagulation factors
- Regulatory mechanisms

= Study the mechanical rules of fluids applied to blood

Goals

.02

Anatomical and histological structural characteristics of the spleen
-> vascular and perivascular ++

Lesional presentation and evolution during blunt trauma

Comparison with an ex vivo reconstruction of a blunt spleen trauma with contrast blush using reperfusion of the organ.

Methods

.03

Normal spleen

- Bilbiography
- Histological sections
- Synchrotron imaging

Traumatized spleen

- Trauma reproduction on fresh body
- Histological sections

TRAUMA EXPERIENCE

jar with circulation liquid
at 37°

manometer

2-way system

pressure transducer

image intensifier

Bag of perfusion fluid

traumatized spleen

cannula

contrast fluid

TRAUMA EXPERIENCE

100 mmHg

120 mmHg

Variations of the intra splenic pressure before the trauma

Variations of the intra splenic pressure during the trauma

.04

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Results

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INFO

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Development

.04

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INFO

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.04

Development

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INFO

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Development

INFO

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INFO

Development

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Data

Subtitle here

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Development

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INFO

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INFO

Development

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INFO

Hypothesis

.05

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Methodology

.06

Population and sample

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Fieldwork

INFO

INFO

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INFO

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Results

.07

Results

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Discussion

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Conclusion

.08

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INFO

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Any questions?

Thanks for your attention