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ÇAY Eİ, ÖZANDAÇ POLAT S, OKSÜZLER M, GÖKER P. Aksesuar dalak varyasyonu. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.911687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Schagatay E, Holmström P, Mulder E, Limbu P, Schagatay FS, Engan H, Lodin-Sundström A. Spleen Volume and Contraction During Apnea in Mt. Everest Climbers and Everest Base Camp Trekkers. High Alt Med Biol 2021; 21:84-91. [PMID: 32182148 DOI: 10.1089/ham.2019.0028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The human spleen can contract and transiently boost the blood with stored erythrocytes. We measured spleen volume and contraction during apneas in two groups, each containing 12 Caucasian participants (each 3 women): one group planning to summit Mt. Everest (8848 m; "Climbers") and another trekking to Everest Base Camp (5300 m; "Trekkers"). Tests were done in Kathmandu (1370 m) 1-3 days after arrival, before the Climb/Trek. Age, height, weight, vital capacity, resting heart rate, and arterial oxygen saturation were similar between groups (not significant). After 15 minutes of sitting rest, all participants performed a 1-minute apnea and, after 2 minutes of rest, 1 maximal duration apnea was performed. Six of the climbers did a third apnea and hemoglobin concentration (Hb) was measured. Three axial spleen diameters were measured by ultrasonic imaging before and after the apneas for spleen volume calculation. Mean (standard deviation) baseline spleen volume was larger in Climbers [367 (181) mL] than in Trekkers [228 (70) mL; p = 0.022]. Spleen contraction occurred during apneas in both groups, with about twice the magnitude in Climbers. Three apneas in six of the Climbers resulted in a spleen volume reduction from 348 (145) to 202 (91) mL (p = 0.005) and an Hb elevation from 147.9 (13.1) to 153.3 (11.3) g/L (p = 0.024). Maximal apneic duration was longer in Climbers [88 (23) seconds vs. 67 (18) seconds in Trekkers; p = 0.023]. We concluded that a large spleen characterizes Climbers, suggesting that spleen function may be important for high-altitude climbing performance.
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Affiliation(s)
- Erika Schagatay
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.,Swedish Winter Sports Research Centre, Mid Sweden University, Ostersund, Sweden
| | - Pontus Holmström
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Eric Mulder
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Prakash Limbu
- Department of Clinical Physiology, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Matsuzawa H, Munakata S, Momose H, Tsuchiya Y, Ishiyama S, Kamiyama H, Takahashi M, Sakamoto K. A Progressive Huge Accessory Spleen in the Greater Omentum. Case Rep Gastroenterol 2020; 13:539-543. [PMID: 31966029 PMCID: PMC6959113 DOI: 10.1159/000504433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/29/2019] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Hirokazu Matsuzawa
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shinya Munakata
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hirotaka Momose
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yuki Tsuchiya
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shun Ishiyama
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hirohiko Kamiyama
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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Palumbo V, Mannino M, Teodoro M, Menconi G, Schembari E, Corsale G, Di Carlo I, Toro A. An extremely rare case of an oversized accessory spleen: case report and review of the literature. BMC Surg 2019; 19:45. [PMID: 31029135 PMCID: PMC6487026 DOI: 10.1186/s12893-019-0510-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/16/2019] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- V. Palumbo
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy
| | - M. Mannino
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy
| | - M. Teodoro
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy
| | - G. Menconi
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy
| | - E. Schembari
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy
| | - G. Corsale
- Department of Radiology, Cannizzaro Hospital, Catania, Italy
| | - I. Di Carlo
- Department of Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy
| | - A. Toro
- Department of General Surgery, E. Muscatello Hospital, Augusta, (SR) Italy
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Kim JS, Chong A, Kim SM. Diagnosis of gastric subepithelial mass as an accessory spleen using fusion of spleen SPECT and CT images. Radiol Case Rep 2018; 13:1137-1140. [PMID: 30233745 PMCID: PMC6138863 DOI: 10.1016/j.radcr.2018.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 11/16/2022] Open
Abstract
More than 10% of the healthy population has one or more accessory spleens. An accessory spleen can be mistaken for a gastric subepithelial mass, and may not be differentiated by CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 52-year-old man with a history of splenectomy 10 years previously for trauma. Subsequent EUS and CT located the subepithelial mass on the fourth layer of the stomach fundus. A definitive diagnosis was obtained by performing technetium-99m (99mTc-)-labeled denatured red blood cell (RBC) scintigraphy. Fusion images were obtained by combining the digital CT and SPECT images on a computer workstation. Here, we report the use of spleen SPECT and CT fusion images to diagnose a case of accessory spleen mimicking a gastric subepithelial mass, thereby avoiding the need for an invasive procedure.
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Affiliation(s)
- Jin-Suk Kim
- Department of Nuclear Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Sun Moon Kim
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea
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Shen YT, Zhou CH, Tang W, Wu W, Chen GQ, Hu DM. Accessory Spleen Presenting as a Submucosal Lesion on Stomach Wall after Splenectomy. Chin Med J (Engl) 2018; 131:869-870. [PMID: 29578135 PMCID: PMC5887750 DOI: 10.4103/0366-6999.228240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Ya-Ting Shen
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Chun-Hua Zhou
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Wen Tang
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Wei Wu
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Guang-Qiang Chen
- Radiology Center, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Duan-Min Hu
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
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Almazeedi S, Alhaddad E, Al-Khithr T, Alhunaidi M. Incidental gastric accessory spleen during laparoscopic sleeve gastrectomy. Int J Surg Case Rep 2017; 36:119-121. [PMID: 28558346 PMCID: PMC5447567 DOI: 10.1016/j.ijscr.2017.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic sleeve gastrectomy’s have now become the most common performed bariatric procedures as of 2014. Although uncommon, the incidental finding of accessory spleens on the stomach may affect the process of the surgery. The prompt and effective management of this finding is of importance for the prognosis of the patient. Although this finding is mostly benign, it is crucial to resect and analyze via histopathology as for the safety of the patient. Introduction Bariatric surgery has shown to produce the most predictable and tangible results for weight loss, with laparoscopic sleeve gastrectomy’s being the most popular one of them. However, the occurrence of previously undiagnosed diseases can be encountered during bariatric operations. The work has been reported in line with the SCARE criteria. Case presentation This is the case of a 54 year old morbidly obese female, presenting to our hospital for a laparoscopic sleeve gastrectomy. During her procedure, it was discovered that she has an accessory spleen on the fundus of her stomach. The decision was made to resect it with the specimen of the stomach for histopathalogical examination. Conclusion Incidental findings during routine bariatric surgery are a common occurance, and therefore prompt and effective intra-op management is key to the prognosis of the patient. Accessory spleens, although uncommon, tend to be asymptomatic. However, if undiagnosed, could present with dangerous consequences.
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Affiliation(s)
- Sulaiman Almazeedi
- Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait.
| | - Eliana Alhaddad
- Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait.
| | - Talal Al-Khithr
- Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait.
| | - Mohammed Alhunaidi
- Department of Surgery, Amiri Hospital, Kuwait Ministry of Health, Kuwait.
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Xiao SM, Xu R, Tang XL, Ding Z, Li JM, Zhou X. Splenosis with lower gastrointestinal bleeding mimicking colonical gastrointestinal stromal tumour. World J Surg Oncol 2017; 15:78. [PMID: 28399879 PMCID: PMC5387232 DOI: 10.1186/s12957-017-1153-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background Splenosis refers to the heterotopic transplantation of splenic tissue following splenic trauma or splenectomy. Splenosis is typically asymptomatic and is often identified incidentally. Case presentation We report a case of splenosis with colon and stomach invasion presenting as lower gastrointestinal bleeding and mimicking colonic gastrointestinal stromal tumour (GIST). The importance of suspicion for splenosis in patients with a history of splenic injury should be highlighted. Computed tomography (CT)-guided biopsy, nuclear scintigraphy and ferumoxide-enhanced magnetic resonance imaging (MRI) can support an accurate diagnosis. Conclusions An accurate diagnosis of splenosis is important to avoid unnecessary operations, especially in patients with previous histories of splenic trauma or splenectomy.
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Affiliation(s)
- Shuo-Meng Xiao
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Rui Xu
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Xiao-Li Tang
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Zhi Ding
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China
| | - Ji-Man Li
- Department of Pathology, Sichuan Cancer Hospital, Chengdu, China
| | - Xiang Zhou
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, No.55, South 4th Section, Renmin Road, Chengdu, Sichuan Province, China.
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Surgical treatment of liver cirrhosis and hypersplenism with huge accessory spleen – A case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2017. [DOI: 10.1016/j.ijso.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Maharaj R, Ramcharan W, Maharaj P, Greaves W, Warner WA. Right sided spleen laying retro-duodenal: A case report and review of the literature. Int J Surg Case Rep 2016; 24:37-42. [PMID: 27179335 PMCID: PMC4872470 DOI: 10.1016/j.ijscr.2016.04.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 04/25/2016] [Accepted: 04/28/2016] [Indexed: 02/07/2023] Open
Abstract
This is the first reported right accessory spleen laying retro-duodenal reported. This is the second largest accessory spleen reported. Accessory spleen is a possibility in a retroperitoneal tumor differential diagnosis. 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.
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Affiliation(s)
- Ravi Maharaj
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago.
| | - Wesley Ramcharan
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago.
| | - Paramanand Maharaj
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago.
| | - Wesley Greaves
- Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago.
| | - Wayne A Warner
- Division of Oncology, Siteman Cancer Center, Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
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Maki T, Omi M, Ishii D, Kaneko H, Misu K, Inomata H, Tateno M, Nihei K. Spontaneous hemorrhage from splenic tissue 13 years after total splenectomy: report of a case. Surg Case Rep 2015; 1:91. [PMID: 26943415 PMCID: PMC4593983 DOI: 10.1186/s40792-015-0099-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/01/2015] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Takehiro Maki
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Makoto Omi
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Daisuke Ishii
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Hiroyuki Kaneko
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Kenjiro Misu
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Hitoshi Inomata
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Masatoshi Tateno
- Department of Pathology, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
| | - Kazuyoshi Nihei
- Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan.
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WANG GUANGYAO, CHEN PING, ZONG LIANG. Accessory spleen arising from the gastric fundus mimicking gastrointestinal stromal tumor following splenectomy: A case report. Exp Ther Med 2014; 7:349-351. [PMID: 24396402 PMCID: PMC3881060 DOI: 10.3892/etm.2013.1415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 11/01/2013] [Indexed: 12/21/2022] Open
Abstract
The current case report presents an accessory spleen mimicking gastrointestinal stromal tumor (GIST) of the stomach in a patient who had undergone a splenectomy ~20 years previously. A 61-year-old male, who presented with upper abdominal discomfort lasting three months, underwent gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a smooth, hemispherical mass of ~2 cm in diameter, with homogenous echogenicity originating from the gastric muscular layer. Abdominal contrast-enhanced computed tomography showed that the well-marginated ovoid mass was ~2.6×1.9 cm in size. The patient was diagnosed with GIST. Subsequent therapy consisted of partial gastrectomy. The pathological results indicated the mass contained splenic tissue, which confirmed it to be an accessory spleen. Changes in the postoperative platelet count were noted. The observations of this case study highlight that platelet count should be used as a routine indicator for monitoring accessory spleen arising from gastric fundus lesion.
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Affiliation(s)
- GUANGYAO WANG
- Gastrointestinal Surgery Department, Su Bei People’s Hospital of Jiangsu Province, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - PING CHEN
- Gastrointestinal Surgery Department, Su Bei People’s Hospital of Jiangsu Province, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - LIANG ZONG
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Ahn JY, Jung HY, Kim DH, Choi KD, Song HJ, Lee GH, Kim JH, Hwang HS. Diagnosis of an accessory spleen mimicking a gastric submucosal tumor using endoscopic ultrasonography-guided fine-needle aspiration. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:433-6. [PMID: 22735877 DOI: 10.4166/kjg.2012.59.6.433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Accessory spleen can be mistaken as a gastric subepithelial mass, and may not be differentiated in CT or endoscopic ultrasonography (EUS). A gastric subepithelial mass was detected on routine endoscopy in a 39-year old woman with history of splenectomy. In subsequent CT and EUS, the subepithelial mass was located on the fourth layer of the stomach. To make a definite diagnosis, EUS-guided fine needle aspiration (FNA) was performed, and a splenic tissue was demonstrated in histologic examination. EUS-guided FNA can be beneficial in the diagnosis of accessory spleen which mimics a gastric subepithelial mass.
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Affiliation(s)
- Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, Asan Digestive Disease Research Institute, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea
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Tjaden C, Werner J, Buechler MW, Hackert T. Reactive hypertrophy of an accessory spleen mimicking tumour recurrence of metastatic renal cell carcinoma. Asian J Surg 2011; 34:50-2. [PMID: 21515214 DOI: 10.1016/s1015-9584(11)60019-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 12/10/2010] [Accepted: 01/31/2011] [Indexed: 10/18/2022] Open
Abstract
De novo occurrence of an accessory spleen after splenectomy is worth noting for two reasons. First, it is known that splenectomy can cause reactive hypertrophy of initially inactive and macroscopically invisible splenic tissue. Second, it can mimic tumour recurrence in situations in which splenectomy has been performed for oncological reasons. This might cause difficulties in differential diagnosis and the clinical decision for reoperation. We report the case of a patient with suspected recurrence of renal cell carcinoma after total pancreatectomy and splenectomy for metastatic renal cell carcinoma, which finally revealed an accessory spleen as the morphological correlate of the newly diagnosed mass in the left retroperitoneum.
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Unver Dogan N, Uysal II, Demirci S, Dogan KH, Kolcu G. Accessory spleens at autopsy. Clin Anat 2011; 24:757-62. [DOI: 10.1002/ca.21146] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/05/2010] [Accepted: 01/10/2011] [Indexed: 02/06/2023]
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Quah C, Ayiomamitis GD, Shah A, Ammori BJ. Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary? Surg Endosc 2010; 25:261-5. [PMID: 20567847 DOI: 10.1007/s00464-010-1171-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 05/24/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Some one-fifth of patients may have accessory spleens (AcS) and require their removal at the time of splenectomy to achieve and maintain hematological response. The purpose of this study was to evaluate the benefit of computed tomography (CT) in patients undergoing laparoscopic splenectomy (LS). METHODS All patients who required splenectomy were offered LS and underwent preoperative contrast-enhanced CT scan to detect and locate AcS. The surgeon was not blinded to the result of the CT scan. Patients were followed up to determine if there was recurrent disease. RESULTS Between 2000 and 2007, 58 consecutive patients (31 men) were referred for splenectomy and all underwent LS. Preoperative CT scan detected 11 AcS in 11 patients (19%), of which 9 were confirmed during LS; the remaining 2 patients suffered with ITP preoperatively and had a good hematologic response to LS. At LS, 14 AcS were found in 13 patients (22%), of which 4 patients had negative preoperative CT scan; those additional AcS were readily found and were located close to the lower pole or hilum of the spleen. All removed AcS were confirmed histologically. In one patient who had LS and removal of AcS for ITP a further AcS within the tail of the pancreas was detected 1 year postoperatively on CT after thrombocytopenia relapsed. The sensitivity and specificity of CT scan for the detection of AcS were 60% and 95.6%, and the corresponding values for laparoscopy were 93.3% and 100%, respectively. Pairwise comparison of the ROC curves identified laparoscopy to be associated with a significantly higher area under the curve compared with CT scan (0.967 vs. 0.673; P = 0.004). CONCLUSIONS Accessory spleens can be readily detected at laparoscopy in the vicinity of the spleen; preoperative CT scan for their detection and localization may not be necessary.
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Affiliation(s)
- Conal Quah
- Department of Surgery at Manchester Royal Infirmary, Manchester, UK.
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17
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Rosenblatt GS, Luthringer DJ, Fuchs GJ. Enlargement of accessory spleen after splenectomy can mimic a solitary adrenal tumor. Urology 2009; 75:561-2. [PMID: 19679337 DOI: 10.1016/j.urology.2009.05.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 05/09/2009] [Accepted: 05/30/2009] [Indexed: 11/28/2022]
Abstract
We report on a 72-year-old woman who had previously undergone splenectomy and subsequently presented with an incidental 5-cm adrenal mass. Laparoscopic adrenalectomy was performed, and the mass was identified to be an accessory spleen. Remaining accessory splenic tissue may undergo compensatory hypertrophy after splenectomy. When a biochemically inactive, well-marginated ovoid adrenal mass is identified in a postsplenectomy patient, consideration should be given to the presence of accessory spleen. In such cases, radionuclide imaging with technetium sulfur colloid may provide information that would confirm the presence of accessory normal tissue and would therefore support observation rather than surgical resection.
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Affiliation(s)
- Gregory S Rosenblatt
- Department of Surgery, Division of Urological Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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18
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Kim MK, Im CM, Oh SH, Kwon DD, Park K, Ryu SB. Unusual presentation of right-side accessory spleen mimicking a retroperitoneal tumor. Int J Urol 2008; 15:739-40. [PMID: 18786195 DOI: 10.1111/j.1442-2042.2008.02078.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Myung K Kim
- Department of Urology, Chonnam National University Medical School and Research Institute of Medical Sciences, Gwangju, Korea
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19
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Chin S, Isomoto H, Mizuta Y, Wen CY, Shikuwa S, Kohno S. Enlarged accessory spleen presenting stomach submucosal tumor. World J Gastroenterol 2007; 13:1752-4. [PMID: 17461483 PMCID: PMC4146959 DOI: 10.3748/wjg.v13.i11.1752] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A 62-year-old man presented with upper abdominal discomfort underwent upper gastrointestinal endoscopy. Gastroscopy and endoscopic ultrasonography revealed a submucosal tumor (SMT) with homogenous echogenicity originated from extragastric organs. An abdominal contrast-enhanced computed tomography (CT) showed that the well-marginated ovoid mass, approximately 6 cm in diameter, enhanced homogenously to a similar degree as splenic parenchyma. 99mTechnetium sulfur colloid scintigraphy revealed the splenic nature of the mass. A diagnosis of accessory spleen mimicking gastric SMT was made. Subsequent follow-up was uneventful without performing splenectomy.
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Affiliation(s)
- Shunzen Chin
- Second Department of Internal Medicine, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
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20
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Phom H, Kumar A, Tripathi M, Chandrashekar N, Choudhry VP, Malhotra A, Bal CS. Comparative evaluation of Tc-99m-heat-denatured RBC and Tc-99m-anti-D IgG opsonized RBC spleen planar and SPECT scintigraphy in the detection of accessory spleen in postsplenectomy patients with chronic idiopathic thrombocytopenic purpura. Clin Nucl Med 2004; 29:403-9. [PMID: 15192463 DOI: 10.1097/01.rlu.0000129117.55170.fd] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Radionuclide imaging specific for functioning splenic tissue is considered the method of choice to detect an accessory spleen in patients of chronic idiopathic thrombocytopenia purpura (ITP), who present with relapse after splenectomy. Radioimmunospleen scintigraphy with Tc-99m-labeled autologous RBC opsonized with anti-D IgG (RIS) is claimed to be more sensitive and specific than Tc-99m heat-denatured RBC spleen scintigraphy (HDRS) in the detection of an accessory spleen. We compared the efficacy of RIS with HDRBC for the detection of accessory spleens METHODS A total of 45 patients (male:female = 17:28, age range: 6-58 years) who presented with relapse of ITP after splenectomy underwent scintigraphy with both methods. An average of 3 years had passed since surgery. All patients were imaged by a dual-head gamma camera with high-resolution collimators; planar static images and SPECT of abdomen were acquired. RESULTS Accessory spleens were detected in 31% (14 of 45) of patients, 6 had 1 each and 8 had more than 1 (including 1 patient who had 13 accessory spleens). Both methods were concordant in all the patients. There was no difference in the scintigraphic picture (planar and SPECT) or in the size and number of accessory spleens detected. CONCLUSION Tc-99m-labeled anti-D IgG opsonized autologous RBC spleen scintigraphy provides no additional diagnostic information over heat-denatured RBC spleen scintigraphy. Heat-denatured RBC scintigraphy thus remains the procedure of choice in the detection of accessory spleens.
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Affiliation(s)
- Hentok Phom
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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21
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Abstract
We encountered a case of splenic pseudotumor. It contained a cystic portion, and the solid portion of the mass showed much higher vascularity than the proper spleen on dynamic CT. An accessory spleen was considered most likely, but the differential diagnosis still included malignant lymphoma and metastatic tumor. The diagnosis was obtained by technetium-99m Sn colloid scintigraphy.
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Affiliation(s)
- Toyotsugu Ota
- Department of Radiology, Mitsubishi Kyoto Hospital, Japan.
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22
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23
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Bertolotto M, Gioulis E, Ricci C, Turoldo A, Convertino C. Ultrasound and Doppler features of accessory spleens and splenic grafts. Br J Radiol 1998; 71:595-600. [PMID: 9849381 DOI: 10.1259/bjr.71.846.9849381] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
16 splenic grafts and 24 accessory spleens were evaluated with ultrasound, colour Doppler and power Doppler imaging, in order to compare the features of splenic grafts and accessory spleens. 12 splenic grafts (11 surgically implanted, 1 islet of splenosis) were detected in eight patients following splenectomy 6-12 months previously. Four of the surgically implanted splenic grafts were found in three patients following splenectomy 16-18 days previously. 21 accessory spleens were incidentally detected in 20 subjects who had not been operated upon, whereas three enlarged accessory spleens were found in 10 patients who underwent splenectomy 6-12 months previously. The size, shape, rim features, echogenicity, acoustic enhancement and vascularization of the splenic grafts and accessory spleens were evaluated. The splenic grafts were oval with lobulated margins, an inhomogeneous pattern in 36% and acoustic enhancement in 64%. Multiple feeding vessels arising from the surrounding tissue entered the periphery of 10 splenic grafts in the eight patients operated on 6-12 months previously, whereas no vascular signals were detected in the four splenic grafts of the three patients operated on 16-18 days ago. Accessory spleens were round with smooth echogenic margins and a vascular hilum arising from the splenic vessels. In conclusion colour Doppler and power Doppler allow differentiation between accessory spleens and splenic grafts basing on their shape and vascular supply.
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Affiliation(s)
- M Bertolotto
- Department of Radiology, Ospedale di Cattinara, Trieste, Italy
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24
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Holloway BJ, Pei L, Pfister R. Case report: portal hypertension causing massive enlargement of an accessory spleen -- a rare cause of splenic pseudotumour. Clin Radiol 1997; 52:882-4. [PMID: 9392471 DOI: 10.1016/s0009-9260(97)80091-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- B J Holloway
- Department of Radiology, Louisiana State University Medical Center, New Orleans, USA
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25
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Suga K, Nishigauchi K, Shimizu K, Kume N, Matsunaga N, Sato Y, Tangoku A, Kouichi N, Esato K. SPECT with In-111 autologous platelets to detect residual splenic tissue in two patients with relapsed thrombocytopenia. Clin Nucl Med 1997; 22:141-6. [PMID: 9067665 DOI: 10.1097/00003072-199703000-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In two patients with relapsed thrombocytopenia, the authors used SPECT with In-111 labeled autologous platelets to identify residual splenic tissue after splenectomy. One case involved a previously splenectomized patient with idiopathic portal hypertension, while the other had relapsed chronic idiopathic thrombocytopenic purpura (ITP). In both patients, SPECT showed a higher In-111 uptake in the splenic tissues compared with planar images. In the patient with ITP, a small accessory spleen had been overlooked on abdominal CT because of post-operative changes, but it was identified by superimposition of SPECT/CT images. These cases indicate that In-111 platelet SPECT is useful in detecting and localizing residual accessory splenic tissue associated with relapsed thrombocytopenia.
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Affiliation(s)
- K Suga
- Department of Radiology, Yamaguchi University School of Medicine, Japan
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26
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Yoshida S, Suematsu T, Motohara T, Ogawa K, Koizumi T, Mizutani M, Yanase M, Fujihara H, Haranomura H, Ishikawa Y. SPECT demonstration of splenosis. Ann Nucl Med 1992; 6:99-102. [PMID: 1622731 DOI: 10.1007/bf03164650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Splenosis is defined as the heterotopic autotransplantation of splenic tissue. The main cause of splenosis is splenic rupture following abdominal trauma, in which fragments of splenic tissue are seeded throughout the peritoneal cavity. Demonstration of splenosis by scintigraphy or CT imaging has been reported, but there is no previous report of simultaneous demonstration by SPECT and CT imaging. Autotransplantation of splenic tissue in the abdominal cavity forms a solid tumor-like image on CT and is difficult to differentiate from other abdominal masses. In such cases, SPECT demonstration of splenosis is very important for identification of its exact site. A case report of splenosis is presented, in which simultaneous demonstration by SPECT and CT was performed. This was confirmed at laparotomy for gastrectomy.
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Affiliation(s)
- S Yoshida
- Department of Radiology, Hyogo Medical Center for Adults, Japan
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27
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Goodman P, Raval B, King FA. Spontaneous necrosis and hemorrhage in an enlarged accessory spleen: CT demonstration. Comput Med Imaging Graph 1990; 14:201-3. [PMID: 2346928 DOI: 10.1016/0895-6111(90)90061-f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Enlargement of an accessory spleen following splenectomy may be due to compensatory hypertrophy or recurrence of hematologic or other disorders. Spontaneous necrosis and hemorrhage in an accessory spleen are rarely described. We report a case in which an enlarged accessory spleen complicated by spontaneous hemorrhage was identified on computed tomography (CT) and confirmed at surgery.
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Affiliation(s)
- P Goodman
- University of Texas Medical School, Department of Radiology, Houston 77030
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28
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Delamarre J, Capron JP, Drouard F, Joly JP, Deschepper B, Carton S. Splenosis: ultrasound and CT findings in a case complicated by an intraperitoneal implant traumatic hematoma. GASTROINTESTINAL RADIOLOGY 1988; 13:275-8. [PMID: 3290038 DOI: 10.1007/bf01889080] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case of intraperitoneal splenosis, found incidentally at ultrasound examination in a 35-year-old man, is reported. The diagnosis, suspected on the basis of computed tomographic (CT) and radionuclide studies, was established by surgery. Three years later, after direct trauma, ultrasound and CT studies revealed a surgically proven splenosis implant hematoma. The contribution of radiologic examinations in the diagnosis of splenosis is emphasized.
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Affiliation(s)
- J Delamarre
- Service de Radiologie A, Centre Hospitalier Universitaire, Amiens, France
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29
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Koyanagi N, Kanematsu T, Sugimachi K. Preoperative computed tomography and scintigraphy to facilitate the detection of accessory spleen in patients with hematologic disorders. THE JAPANESE JOURNAL OF SURGERY 1988; 18:101-4. [PMID: 3386065 DOI: 10.1007/bf02470854] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Accessory spleens of 1.5 cm in size were preoperatively identified by the combined use of computerized tomography and splenic scintigraphy in two patients with hematologic diseases. After the accessory spleen had been removed from the first patient, who had persistent hereditary spherocytosis and had undergone a splenectomy 15 months before, a postoperative decrease in hyperbilirubinemia was noted. In the other patient who had idiopathic thrombocytopenic purpura, a successful accessory splenectomy was done at the same time as her splenectomy, and was followed by 6 months' complete remission. These events indicate that preoperative investigations using computerized tomography and scintigraphy are indispensable for ruling out an accessory spleen in those patients for whom splenectomy needs to be done in order to alleviate hematologic disorders.
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Affiliation(s)
- N Koyanagi
- Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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30
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Mostbeck G, Sommer G, Haller J, Herold C, Jaeger U, Canigiani C, Czembirek H. Accessory spleen: presentation as a large abdominal mass in an asymptomatic young woman. GASTROINTESTINAL RADIOLOGY 1987; 12:337-9. [PMID: 3305132 DOI: 10.1007/bf01885176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Accessory spleen hypertrophy is usually related to hematologic, lymphomatous, and rheumatoid diseases. We describe here the case of an 18-year-old asymptomatic woman who presented with a very large accessory spleen occupying the lower abdomen. Its appearance on abdominal sonogram, computed tomogram, and hepatosplenic scintigraphy is correlated with the resected specimen.
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31
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Voet D, Afschrift M, Nachtegaele P, Delbeke MJ, Schelstraete K, Benoit Y. Sonographic diagnosis of an accessory spleen in recurrent idiopathic thrombocytopenic purpura. Pediatr Radiol 1983; 13:39-41. [PMID: 6682548 DOI: 10.1007/bf00975665] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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