Accessory spleen in the greater omentum

A case of symptomatic intramesenteric accessory spleen: The diagnostic role of contrast-enhanced ultrasound

Introduction

Accessory spleen is a congenital defect characterised by a separated ectopic splenic parenchyma usually located in the splenic hilum and the tail of the pancreas. It is present in about 10%-30% of the population and, generally, does not cause any symptoms.

Case report

We report an interesting case of a woman with symptomatic intramesenteric accessory spleen detected and characterised by contrast-enhanced ultrasound. The patient experienced a long history of intermittent pain in the left upper abdomen. The diagnosis was confirmed by post-operative pathology examination.

Discussion

Accessory spleen usually appears as a well-circumscribed ovoid mass, 1-3 cm in diameter, infrequently located in the mesentery. It may rarely become symptomatic because of complications. Diagnosis of this condition as a cause of abdominal is difficult and rarely has been made pre-operatively. Computed tomography and magnetic resonance imaging might help, but they should be performed with intravenous contrast injection, and they cannot provide direct evidence between the pain of the patient and the lesion. Conversely, real-time ultrasound can assess and diagnose the lesion showing the exact correspondence with abdominal pain of the patient. Furthermore, ultrasound and contrast-enhanced ultrasound are widely available, safe and relatively inexpensive.

Conclusion

Apart from the rarity of this condition, this case report demonstrates the ability of ultrasound to localise the intramesenteric accessory spleen, assess the relationship between the lesion and the symptoms of the patient, and characterise the lesion.

Huge accessory spleen with torsion, mimicking splenic lymphangioma: A case report and review of the literature

INTRODUCTION AND IMPORTANCE

Approximately 30 % of population can have an accessory spleen, which is most often asymptomatic. Only when it becomes large in size, it may elicit symptoms, mostly due to complications, such as torsion, infarction, or traumatic hemorrhage. The preoperative diagnosis of an accessory spleen is often challenging due to its propensity to manifest the neoplasms of adjacent organs. Here we report a rare case of a huge tortured accessory spleen mimicking splenic lymphangioma and to review the literature.

CASE PRESENTATION

A 27-year-old man was admitted to the emergency department following left hypochondrial pain that lasted for three days. The computed tomography scan findings demonstrate the spleen in its normal position, showing smooth outlines attached to a similar-density cystic heterogenous mass exhibiting strong radiological evidence of splenic lymphangioma. Surgical excision was performed, and a large tortured accessory spleen was discovered that was attached to the lower pole of the spleen by connective tissue.

CLINICAL DISCUSSION

An accessory spleen is always smaller than 4 cm, and accessory spleens larger than that, especially with torsion, are extremely uncommon. According to literature, the identification of accessory spleen on the basis of clinical and radiological features is very difficult, especially when the patient presents with symptoms of acute abdomen.

CONCLUSION

Considering the fact that accessory splenic tissue can mimics neoplasms of the spleen or nearby organs, it should be included in the differential diagnosis in an undiagnosed pre- or intraoperative hypochondrial mass, located in the vicinity of the spleen.

A Progressive Huge Accessory Spleen in the Greater Omentum

Huge accessory spleen (AS) is a rare condition difficult to diagnose. We recently treated a Japanese woman with a progressive huge AS. She had a history of aortic valve replacement for aortic stenosis 1 month prior. At that time, a 4-cm AS had been detected by the preoperative computed tomography (CT). This mass was a progressive tumor which grew to 7 cm over the course of 3 months. Thus, we performed surgery with a preoperative diagnosis of huge AS by CT and positron emission tomography. A laparoscopic resection was performed considering the risk of torsion, spontaneous rupture, or hemorrhage. The final pathological diagnosis was AS. This is the first reported case in the English literature of progressive AS with no symptoms at the initial presentation that was treated with laparoscopic resection.

An extremely rare case of an oversized accessory spleen: case report and review of the literature

BACKGROUND

The accessory spleen is a congenital defect characterized by a separated ectopic splenic parenchyma. The size is rarely more than 4 cm. The preoperative diagnosis is prohibitive preoperatively. The aims of the present manuscript were to present the case of a patient with a rare oversize accessory spleen and a review of the literature.

CASE PRESENTATION

A 15-year-old boy was admitted to the emergency department following blunt abdominal trauma. The computed tomographic scan showed a traumatic rupture of the spleen and a 7-cm mass at the left side of the retroperitoneal space. Conservative treatment started and aborted after 4 h due to the onset of haemodynamic instability. Splenectomy was performed. An accessory spleen was discovered. A second large mass in the retroperitoneum was diagnosed as a second large accessory spleen that was also left in place. The postoperative course was uneventful, and the patient was discharged on the 7th postoperative day. Seven months later, the CT scan showed viability of both accessory spleens.

CONCLUSION

An accessory spleen can be variously located and the retroperitoneal position is extremely uncommon. Preoperative diagnosis is still difficult, especially in emergency and as in our case, the literature shows the difficulty of reaching a diagnosis before surgery. The main misdiagnosis is neoplastic disease and for this reason accessory spleen can be wrongly removed. An undiagnosed pre or intra operative retroperitoneal mass, closely to the spleen, have to be managed carefully. The diagnosis of accessory spleen needs to be ever considered as if found, represents a great possibility to conduct a normal life after splenectomy (of main spleen) for trauma.

A Rare Case of Spontaneous Hemorrhage in a Giant Accessory Spleen in a Child

Accessory spleen (AS) is a condition found in about 20% of patients and is most commonly located in the hilar region of the spleen. It is more often asymptomatic, single, and smaller than 2 cm. In the present study, we report the rare case of a 13-year-old boy with giant accessory spleen underwent spontaneous intrasplenic hemorrhage who presented with recurrent abdominal pain. Contrast-enhanced MRI was mandatory for the diagnosis before surgical procedure.

Accessory spleen located in the right parietal peritoneum: The first case report

RATIONALE

Accessory spleen is a congenital abnormality caused by failure of the splenic anlage to fuse during embryology. The presence of an accessory spleen located in the parietal peritoneum has not been reported so far, and an accessory spleen situated on the right side is extremely rare. In the present study, we describe the first case of an accessory spleen located in the right parietal peritoneum.

PATIENTS CONCERNS

A 65-year-old man, presented with pain in his left abdomen for 1 month.

DIAGNOSES

With ultrasonography and computed tomography, it was difficult to determine the accurate location and diagnosis, and an abdominal fibroma was preoperatively considered.

INTERVENTIONS

By laparotomy, we found a mass connected to the right parietal peritoneum by a vascular pedicle. We resected it completely, and the gross specimen measured 5.0 × 3.0 × 2.5 cm and was a localized tumor with a capsule.

OUTCOMES

Microscopically, sinusoids were visible, as well as scattered lymphoid follicles, eosinophils, histiocytes, plasma cells, neutrophils, and red blood cells, indicative of splenic tissue. Finally, the lesion was diagnosed as an accessory spleen located in the right parietal peritoneum. Postoperatively, he recovered well and was followed up for a 31 months, during which he was well with no complication.

LESSONS

We present the first accessory spleen located in the right parietal peritoneum. Awareness of the accessory spleen and familiarity with typical imaging findings are necessary for surgeons to make a precise preoperative diagnosis.

Accessory Spleen in the Splenic Hilum: a Cadaveric Study with Clinical Significance

Aim:

An accessory spleen is an additional tissue of the spleen that may be found near the spleen. It is a congenital anomaly of the spleen that its incidence has been reported 10-30% of the population. Hence, the objective of this study was evaluation the incidence of accessory spleen in Iranian cadavers.

Method:

Sixty hundred and ninety three spleens (541 males, 152 females) were excised from cadavers in the dissection hall of Mashhad Forensic Medicine Organization cadavers. Inclusion criteria were as follows: Fresh Iranian cadavers with no history of alcohol, poisoning or drug abuse, and no evidence of pathologic abnormality or injury to the spleen. The presence of accessory spleens, its dimension and weight investigated in cadavers.

Results:

During routine postmortem examination, five cases with an accessory spleen were found in the autopsy laboratory of Mashhad legal Medicine Organization between June 2014 and July 2015. Of the cases, 3 were male and 2 were female. The accessory spleens were observed at the splenic hilum. The length of the accessory spleens ranged from 2-3.5 cm, while the range of width was between 0.5 and 2.5 cm. The accessory spleens were confirmed by histological examination.

Conclusion:

An accessory spleen has clinical importance in some locations. When an accessory spleen is situated in another site, it may mimic some tumors such as pancreatic tumor and adrenal tumor. In addition, accessory spleen may cause hyperplasia after splenectomy and be responsible for a recurrence of the hematological disorders.

[Big surprise in the lesser pelvis]

A 17-year-old young man presented at our clinic with asymptomatic microhematuria. Ultrasonography and computer tomography found an intraperitoneal lesion of unknown dignity located on top of the bladder. Surgical exploration and histological examination confirmed the diagnosis of a secondary pelvic spleen, a lien bipartitus.

Rare presentation of a right retroperitoneal accessory spleen: A case report

An accessory spleen is a congenital malformation, which is defined as ectopic splenic parenchyma. Here, an extremely rare case of a right retroperitoneal accessory spleen, mimicking a retroperitoneal neoplasm, is reported. A 40-year-old woman was referred following the incidental detection of a retroperitoneal neoplasm. Computed tomography and magnetic resonance imaging scans confirmed the presence of a retroperitoneal neoplasm at the hepatorenal recess. Retroperitoneoscopic excision was conducted, with excellent results. Pathological examination of the resected specimen revealed splenic tissue. In conjunction with a review of the literature and a discussion of the salient radiological features, the present case highlights the requirement for accurate preoperative diagnosis of an accessory spleen in the right retroperitoneal space, in order to avoid unnecessary surgical intervention.