28.1.1 The pancreas

We have seen that the arterial supply of the pancreas derives mainly from branches of the gastroduodenal artery (via the superior anterior and superior posterior pancreaticoduodenal arteries as intermediaries) and the splenic artery (Fig. 28.1).

Fig. 28.1 Pancreas and spleen.

These two arteries anastomose with the inferior pancreaticoduodenal artery, which runs transversely from the superior mesenteric artery. Remember that the vascular arrangement between the abdominal organs allows the body to compensate for any irrigation deficit.

28.1.2 The spleen

The spleen is a retroperitoneal organ, with a mobility of about 10 cm, weighing on average 200 g (see Fig. 28.1). Unlike lymph nodes, the spleen is connected directly to the blood circulation, making it suitable for visceral vascular manipulation.

The spleen articulates by way of peritoneal folds with the:

We have often emphasized the importance of the left side of the body in relation to trauma. This is an area you must check meticulously for any possible visceral and parietal fixations, especially in the face of unusual, and sometimes disconcerting, symptoms. We have seen, for example, several cases of post-traumatic iron deficiency where the spleen is the cause.

28.1.3 The splenic artery

The splenic artery is the largest branch of the celiac trunk, and its course is amongst the most tortuous in the body. It runs behind the omental bursa, along the superior border of the pancreas (Fig. 28.2).

Fig. 28.2 Splenic artery.

The splenic artery supplies the left gastroepiploic artery at the greater curvature of the stomach. At the tail of the pancreas it divides into several small branches before entering the hylum of the spleen. These branches are sinuous in order to adapt to the spleen’s great mobility.

28.1.4 The inferior pancreatic artery

This artery is also called the transverse pancreatic artery. It links the splenic artery with the pancreaticoduodenal arteries.

28.1.5 Perpendicular branches of the splenic artery

These branches connect the splenic and inferior pancreatic arteries, essentially by way of the greater and dorsal pancreatic arteries.

28.2.1 Right lateral traction technique

To stretch both the transverse pancreatic arteries and the splenic artery, hook the medial border of the duodenum with two flat fingers. Draw the duodenum to the right, while applying a light counterpressure on the left part of the pancreas (Fig. 28.3).

Fig. 28.3 Right lateral traction technique of the pancreas.

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