Acute abdomen due to spontaneous torsion of an accessory spleen

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.

Radiologic Findings of Single Accessory Splenic Infarction in a Patient with Accessory Spleens in the Abdominal Cavity: A Case Report

The presence of multiple accessory spleens in the abdominal cavity is typically limited to two, with cases involving a higher number being exceedingly rare. Concurrently, accessory spleen infarction is remarkably uncommon, primarily resulting from torsion of the vascular pedicle. In this report, we present a case of a 19-year-old male who experienced infarction in one of four accessory spleens. Imaging diagnosis proved challenging, with the definitive diagnosis being made through postoperative pathology, revealing no torsion in the affected accessory spleen. Following surgery combined with anti-inflammatory and analgesic treatment, the patient exhibited an uneventful recovery. No complications were observed at the 3-month follow-up. This case indicates the challenge and difficulty of diagnosing accessory splenic infarction without torsion in imaging diagnosis. Employing a multimodality approach and diffusion-weighted imaging may aid in confirming the diagnosis.

Infarcted wandering spleen: A case report from Saudi Arabia

Spleen is normally positioned in the left upper quadrant. Abnormal location where it is not found in its normal anatomical position is called wandering spleen (WS). Wandering spleen is a rare medical condition that occurs due to developmental abnormality or acquired laxity of the ligaments that hold the spleen in its normal anatomical position. It affects children and young adults, especially childbearing age women. Patients affected with this condition may present with nonspecific symptoms requiring a high index of suspicion. Here, we are presenting a 20-year-old female known to have WS ended up with infarcted WS requiring emergency splenectomy.

Retroperitoneal Abdominal Accessory Splenosis

Accessory splenosis (AS) is an uncommon condition that is formed from the lateral dorsal mesogastrium due to the defective union of separate splenic masses. It is often found next to the pancreatic tail and the hilum part of the spleen. The retroperitoneal is described as an unusual and uncommon site. We present a case of a 39-year-old woman with an AS who came to the clinic with a right abdominopelvic mass. Computerized tomography (CT) scan revealed a right retroperitoneal abdominal mass. Diagnostic laparoscopy and resection of the retroperitoneal mass were done, and histological investigation showed that the removed mass was a spleen. Although retroperitoneal abdominal AS is an unusual condition, it should be considered in the list of abdominopelvic mass differential diagnoses.

Accessory Spleen Fracture: Report of a Pediatric Case and Review of the Literature

Accessory spleen rupture may occur after blunt abdominal trauma or, more rarely, spontaneously. Although only few cases are described in adults, it is even more uncommon in children. We report the case of a 13-year-old boy with traumatic accessory spleen fracture. After a review of the literature, we discuss the diagnostic points that should raise the suspicion for accessory spleen fracture as well as how challenging the diagnosis by computed tomography can be.

Splenosis of the abdomen and pelvis complicated by torsion of a splenic implant clinically mimicking an acute bowel ischemia

We present a case of splenosis of the abdomen and pelvis complicated by torsion of a splenic implant in a young female patient clinically mimicking an acute bowel ischemia. Splenosis is a benign condition defined as heterotopic auto-transplantation of splenic tissue throughout different body areas. It may occur after rupture of the spleen, either traumatic or secondary to surgical procedures. Although the presence of heterotopic splenic tissue is often asymptomatic and an incidental finding, it may present with sudden abdominal pain and bleeding. CT and MRI play a critical role in the detection of splenosis-related complications, such as torsion of the vascular pedicle and infarction. Splenosis torsion is extremely rare and it is still a diagnostic dilemma; the complication of abdominal splenosis should be considered in the differential diagnosis in patients with previous splenectomy.

Wandering spleen with horseshoe kidney a rare occurrence

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Wandering spleen with horseshoe kidney is a rare occurrence with less than 3 cases reported worldwide.

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Delay in diagnosis would result is increased mortality.

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Splenopexy is preferred in children with the exception of grossly infarcted spleen.

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Splenectomy is the treatment of choice in torsion of spleen with infarct.

Introduction

Wandering spleen is a rare clinical entity in itself, with only 2 cases reported thus far when correlated with congenital under-development of the kidney, it usually happens due to under development of its surrounding ligaments. Herein we present a case of wandering spleen with underlying congenital deformity of horseshoe kidney which requires splenectomy due to late presentation.

Presentation of case

A 21 year old lady presented with worsening of chronic abdominal pain for 3 years, associated with nausea and vomiting. Physical examination showed a vague mass located at epigastric region. Consecutively, computed tomography images showed a well-defined, oval, hypoechoic spleen extending from center of abdomen up to epigastric region measuring 15.5 × 13 cm with twisted pedicle. Finally the patient underwent surgical treatment. The intraoperative findings were consistent with computed tomography images. The patient made a full recovery and was discharged well.

Discussion

Wandering Spleen was first described by Van Horne during autopsy back in 1667. Its location is maintained by peritoneal attachments such as lienorenal, splenocolic, splenophrenic, gastrosplenic and phrenicocolic ligaments. Among which, the gastrosplenic ligament and lienorenal ligaments are of greatest significance. Patient with a wandering spleen may present asymptomatic, with a movable mass in the abdomen, or with chronic or intermittent abdominal pain because of partial torsion and spontaneous de-torsion of the spleen as in our case. When feasible especially in young patients, splenopexy should always be the first consideration but however if gross infarct has occurred then splenectomy is inevitable to save the patient.

Conclusion

Wandering spleen is a unique surgical entity moreover when appeared in congruence with horseshoe kidney. Its diagnosis should be made in prompt to prevent splenic infarction and to try to salvage with splenopexy especially in younger population. However in patient where splenic torsion with infarction has occurred, splenectomy would be the treatment of choice.

Colonic obstruction caused by accessory spleen torsion: A rare case report and literature review

RATIONALE

Accessory spleen torsion is a rare cause of the acute abdomen. The complications of accessory spleen torsion, such as intestinal obstruction, are rarer. We herein report a case of colonic obstruction caused by accessory spleen torsion because of the unusual condition.

PATIENT CONCERNS

A 15-year-old patient presented with acute intestinal obstruction with signs of peritoneal irritation. Abdominal computed tomography (CT) and ultrasonography examinations revealed a soft tissue mass in the left midabdomen. Systemic inflammatory response syndrome (SIRS) was observed in this case.

DIAGNOSES

The diagnosis of peritonitis and colonic obstruction secondary to accessory spleen torsion was made. Pathologic examination showed infracted splenic tissue.

INTERVENTIONS

We performed emergency laparotomy and found that accessory spleen torsion pressured against splenic flexure and descending colon, and caused colon obstruction. The patient underwent accessory splenectomy and enteral decompression.

OUTCOMES

At 6 months follow-up, the patient recovered well with perfect digestion.

LESSONS

Accessory spleen torsion and its complications are extremely rare. This entity should be considered in differential diagnosis of acute abdomen. However, in case of acute abdomen with critical clinical situation, emergency surgical intervention is necessary for timely diagnosis and treatment.

Torsion of huge wandering accessory spleen. Case report and review of literature

INTRODUCTION

Accessory spleens are found in 10-15% of the population, and are even more prevalent in patients with hematological disorders (Rudowski, 1985). It infrequently may become symptomatic due to torsion, spontaneous rupture or hemorrhage which may lead to death. Torsion of an accessory spleen is extremely rare, and requires prompt medical attention [2] (Coote et al., 1999).

PRESENTATION OF CASE

We report the case of a 27-year-old Mediterranean lady with thalassemia trait, who presented to the emergency department with an acute surgical abdomen due to torsion of a giant accessory spleen, measuring 13cm. She was diagnosed with the aid of ultrasound and computed tomography (CT) scan and was treated surgically through resection of the spleen.

DISCUSSION AND CONCLUSION

Torsion of an accessory spleen is not common, and is the surgical indication in about 0.2-0.3% of splenectomies (Mortele et al., 2004). It has variable clinical presentations, and is a difficult preoperative diagnosis due to lack of specificity of symptoms. Accessory spleens are usually smaller than 3cm, with few cases being reported as larger than 10cm larger accessory spleens have a higher rate of torsion. Knowledge of this pathology, and familiarity with its radiological findings are fundamental to accurately diagnosing and manageming this challenging condition.

Right sided spleen laying retro-duodenal: A case report and review of the literature

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This is the first reported right accessory spleen laying retro-duodenal reported.

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This is the second largest accessory spleen reported.

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Accessory spleen is a possibility in a retroperitoneal tumor differential diagnosis.

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We present a literature review of the other right accessory spleen cases.

Introduction

Unlike left sided accessory spleen that are seen in 10–30% of cases at autopsy, cases of right accessory spleens are extremely rare. This congenital body of healthy splenic tissue simulates tumors from neighboring organs and presents a challenge in formulating a differential diagnosis.

Presentation of case

We present the case of a patient whose CT scan of the abdomen showed a large mass, 11 × 8 cm, arising retro-duodenal and lying just anterior to the right kidney. To the best of our knowledge, this is the only case where the accessory spleen was found retro-duodenal, directly anterior to the kidney and completely separate from the supra-renal gland. The chief complaint of the patient was right upper quadrant pain, radiating to the back, and colicky in nature. The patient was diagnosed with duodenal gastro-intestinal stromal tumor and a retro-peritoneal sarcoma. The mass was removed via a Kocher’s incision and immunohistological examination showed that it was a right sided accessory spleen. The patient’s left sided spleen appeared normal.

Discussion

Efforts to distinguish an accessory spleen from a retroperitoneal tumor with available scans, percutaneous biopsy or biochemical tests are inconclusive. Differential diagnosis between a retroperitoneal tumor and an accessory spleen can only be made after surgical exploration.

Conclusion

This case highlights the fact that surgeons should consider the possibility of an accessory spleen when making a differential diagnosis of retroperitoneal tumors.

Torsion of an accessory spleen: a rare case preoperatively diagnosed and cured by single-port surgery

We report a very rare case of acute abdomen caused by torsion of an accessory spleen that was preoperatively diagnosed and cured by single-port surgery. A 31-year-old woman was admitted to our hospital with severe left abdominal pain. Physical examination revealed a left upper quadrant abdominal tenderness with voluntary guarding. Ultrasound demonstrated a well-defined round mass isoechoic to the spleen, measuring 3.0 cm in diameter in the left upper quadrant adjacent to the spleen. A contrast-enhanced CT scan showed a normally enhanced spleen and a 3.0 × 3.0, hypodense, non-enhancing mass anterior to the spleen with a twisted funicular structure. Torsion of an accessory spleen was suspected, and emergency single-port surgery was performed. During surgery, a rounded violet mass measuring 3.0 cm in diameter, suggestive of an accessory spleen, with a 1800° torsion around a long vascular pedicle along the left side of the greater omentum was discovered. The mass was removed and post-operative recovery was uneventful. A review of the literature revealed 26 cases (including ours) of torsion of an accessory spleen in English. Even with the recent advances in radiologic imaging modalities, making a preoperative diagnosis of this is difficult and most cases are diagnosed during laparotomy. This is the first report preoperatively diagnosed and cured by single-port surgery. We decided to start the operation by using a single port, not only for cosmetic reasons for this young female patient, but also for final confirmation of our diagnosis. We believe that single-port laparoscopy is valuable as a diagnostic tool as long as safety is assured for patients with acute abdomen. Although torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in children and young adults.

Spontaneous hemorrhage from splenic tissue 13 years after total splenectomy: report of a case

A 33-year-old man suffered sudden abdominal distension without traumatic episodes. He had undergone total splenectomy for hereditary spherocytosis 13 years ago. He was in shock, and his hemoglobin level was 10.5 g/dl. Contrast enhanced computed tomography revealed a giant mass in the left upper abdomen and extravasation of the contrast material into the mass. Excision of the mass was performed, and microscopic examination showed a giant hematoma surrounded by normal splenic tissue. We speculated that an accessory spleen or splenosis had enlarged for the 13 years and ruptured. The patient remained asymptomatic 4 months after the surgery. Spontaneous hemorrhage from accessory spleens or splenosis is extremely rare, and relevant case reports suggest that surgical resection of bleeding sites yields favorable prognosis although preoperative qualitative diagnosis seems to be difficult.

Accessory spleen in the pelvis: A case report

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Ectopic splenic tissue can be either congenital (accessory spleen) or acquired (splenosis).

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Accessory spleen (AS) is commonly located near the spleen’s hilum and in the pancreas tail.

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Pelvic AS is a very rare entity.

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AS is generally determined incidentally during radiological investigation or surgery.

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Pelvic AS may be considered in differential diagnosis of adnexal masses.

Introduction

Accessory Spleen (AS) is a very rare entity and usually near the spleen’s hilum and in the tail of the pancreas. Pelvis reported as an atypical and a rare localization. AS may be formed during embryonic life, they rise from the left side of the dorsal mesogastrium as a result of imperfect fusion of separate splenic masses.

Presentation of case

We report a case of an AS presenting as an left adnexal mass in a middle-aged woman. Transvaginal ultrasonography and magnetic resonance imaging (MRI) revealed a left adnexial mass. Laparatomy was performed, and histological examination revealed that resected mass was splenic tissue.

Discussion

An AS is an incidental finding of no clinical significance in most patients. AS are generally determined during radiological investigations or during open or laparoscopic surgeries. When, the AS settle in the adnexal area; the differential diagnosis could include the causes of adnexal masses like enlarged lymph nodes, subserous fibroid, ovarian tumors, organized hematoma, tuboovarian abscess.

Conclusion

Althought pelvic accessory spleen is a rare condition, should be considered in the differential diagnosis of adnexal masses.

Wandering spleen in an adult man associated with the horseshoe kidney

INTRODUCTION

A wandering spleen occurs when there is a laxity of the ligaments that fix the spleen in its normal anatomical position.

CASE PRESENTATION

This is a case report of a wandering spleen with horseshoe kidney in a 29-year-old male admitted with acute lower abdominal pain and vomiting to emergency department of Shariati hospital in Isfahan province. Sonographic examination showed a homogeneous 21 × 15 × 8 cm mass in the lower part of the abdomen and pelvis associated with a horseshoe kidney. Laparotomy confirmed the clinical and ultrasound findings.

CONCLUSIONS

The association of horseshoe kidney with a wandering spleen in this case may be due to an embryological anomaly.

A rare cause of chronic abdominal pain: recurrent sub-torsions of an accessory spleen

Accessory spleen is defined as one, two, or three nodules of additional ectopic splenic parenchyma hung by a vascular pedicle generally near the spleen. Despite a relatively high frequency (from 10 to 30 % of the population based on autopsy studies), most accessory spleens are asymptomatic. Although cases of accessory spleen were clearly described in the literature, this perplexing diagnosis is often delayed and rarely made preoperatively. We report episodic recurrences of abdominal pain in a 66-year-old man attributed to iterative sub-torsions of an accessory spleen, as well as a comprehensive review of the literature.

Torsion of an accessory spleen: Case report and review of the literature

Torsion of an accessory spleen is an uncommon cause of abdominal pain. Only a few cases have been reported in the literature. Most cases occur in children, and in most cases the diagnosis is made at surgery. We report a case of torsion of an accessory spleen in an adult female who presented with acute left-flank pain. The diagnosis was made on contrast-enhanced computed tomography (CT) and was confirmed at surgery. Without treatment, torsion of an accessory spleen can lead to hemorrhagic shock, peritonitis, and bowel obstruction. It is useful for the radiologist to make this diagnosis on imaging so that biopsy can be avoided and surgery performed to avoid complications.

Unusual presentation of right-side accessory spleen mimicking a retroperitoneal tumor

An unusual case of right-side retroperitoneal accessory spleen is presented. A 68-year-old man visited our hospital for the management of incidentally detected retroperitoneal mass. The computed tomography scan of the abdomen revealed the presence of a retroperitoneal tumor (4.0 x 3.8 cm) at the right suprarenal space. Laparoscopic excision was carried out with excellent results. On histological examination, the tumor exhibited a structure typical of splenic tissue. This accessory spleen was unusual in its size and location. Though it existed at the right side, surgeons should be aware of the possible existence of accessory spleens for the differential diagnosis of retroperitoneal tumors.

Symptomatic pelvic accessory spleen

Accessory spleens are found most commonly at the splenic hilum, however, they rarely are symptomatic. An 18-year-old man presented with lower abdominal pain. Cross-sectional imaging studies with 3-dimensional reconstruction suggested the presence of a mass that was associated with the spleen. A nuclear medicine radioisotope scan confirmed that the mass was a pelvic accessory spleen. Laparoscopic excision was performed with excellent results. This accessory spleen was unusual in its size and location. Accessory spleens should be removed if symptomatic or if they are identified at splenectomy for hematologic disease.

Torsion of an accessory spleen

Torsion of an accessory spleen is extremely rare. We report a case of an acute torsion of an accessory spleen in a young patient who presented with acute left abdominal pain and discuss the computed tomographic findings of this exceptional condition. Awareness of this entity and familiarity with typical imaging findings are mandatory for preoperative diagnosis.