Assuntos
Fundoplicatura , Laparoscopia , Esplenopatias , Anormalidade Torcional , Humanos , Fundoplicatura/efeitos adversos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Anormalidade Torcional/cirurgia , Anormalidade Torcional/etiologia , Anormalidade Torcional/diagnóstico , Esplenopatias/cirurgia , Esplenopatias/etiologia , Esplenopatias/diagnóstico , Feminino , Masculino , Criança , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Esplenectomia/métodos , Esplenectomia/efeitos adversos , Pré-Escolar , Tomografia Computadorizada por Raios XRESUMO
ABSTRACT: Splenic abscess is a life-threatening condition, which is very rare in children. There is usually an infective focus or pre-disposing factors such as immunodeficiencies towards developing splenic abscesses. Only one case of splenic abscess with brain abscesses in an adult has been reported in the English literature. We, therefore, report a case of an 11-year-old boy who was otherwise healthy, but presented with fever and weight loss for 2 months, right upper abdominal pain, vomiting, hypochondrial tenderness for 1 week and later on developed a left hemiplegia and right facioparesis 2 days before presentation. Diagnosis of splenic abscess and right intracerebral abscesses was confirmed with abdominopelvic ultrasound scan and abdominal and cranial computerised tomographic scans. He subsequently had percutaneous ultrasound-guided drainage of the splenic abscess which was not successful necessitating splenectomy with aggressive antibiotics treatment to which the patient responded with resolution of the brain abscesses and recovery of power in affected limbs. This report aimed to highlight the need for increased suspicion of splenic abscesses in children who are apparently immunocompetent and to add to the knowledge of management of this rare condition in children. We conclude that splenic abscess with intracerebral abscess is a rare but life-threatening condition which is amenable to treatment with drainage of abscess and aggressive guided antimicrobial therapy.
Assuntos
Abscesso Encefálico , Drenagem , Esplenopatias , Tomografia Computadorizada por Raios X , Humanos , Masculino , Criança , Esplenopatias/cirurgia , Esplenopatias/diagnóstico , Esplenopatias/diagnóstico por imagem , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/cirurgia , Abscesso Encefálico/terapia , Abscesso Encefálico/diagnóstico por imagem , Drenagem/métodos , Antibacterianos/uso terapêutico , Abscesso/diagnóstico , Abscesso/cirurgiaRESUMO
Splenic abscess is a rare complication often associated with sleeve gastrectomy (SG) due to factors including local infections, distant infections, tumors, ischemia, and trauma, which presents substantial challenges. We report four cases of gastrosplenic fistula and/or splenic abscess after SG. Patient data, including demographics, comorbidities, diagnostic procedures, treatments, and outcomes, were recorded. Surgical techniques for SG adhered to established protocols. Four patients had a male-to-female ratio of 2:2, with an average age of 39.8 years and an average preoperative BMI of 38.9 kg/m2. All patients were readmitted due to recurrent fever and chills caused by splenic abscesses detected on CT scans, with an average admission duration of 16.5 weeks. Treatments varied from fasting and antibiotics to percutaneous drainage and surgical interventions. The average treatment duration post-diagnosis of splenic abscess was 37.25 weeks. Managing gastrosplenic fistula and/or splenic abscess is complex, underscoring the significance of prompt diagnosis and proper treatment. This highlights the need for heightened awareness among healthcare professionals to promptly recognize and manage this rare complication after SG.
Assuntos
Abscesso , Gastrectomia , Fístula Gástrica , Esplenopatias , Humanos , Feminino , Masculino , Esplenopatias/etiologia , Esplenopatias/cirurgia , Adulto , Fístula Gástrica/etiologia , Fístula Gástrica/cirurgia , Gastrectomia/efeitos adversos , Abscesso/etiologia , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/etiologia , Drenagem , Antibacterianos/uso terapêutico , Resultado do Tratamento , Tomografia Computadorizada por Raios X , Abscesso Abdominal/etiologiaRESUMO
Laparoscopic fenestration is the preferred treatment for symptomatic splenic cysts because it is curative and spleen-sparing. We report a case of a 25-year-old female who underwent laparoscopic fenestration for a giant splenic cyst using a single-incision plus one-port approach. She presented to our hospital with repeated vomiting. Imaging showed a 23 × 18 cm splenic cyst with no solid components, strongly compressing the stomach to the right side. Laparoscopic fenestration was initiated through a 2.5-cm umbilical incision, and a 5-mm port was added in the left abdomen intraoperatively. The drain placement was deemed necessary to prevent abscess formation and post-operative bleeding because of a thick cyst component and unexpectedly thick wall. Splenic cysts are typically benign and commonly develop in young people, hence, organ preservation and cosmetic results are crucial. Laparoscopic fenestration using single-incision plus one-port is considered to be an appropriate procedure for giant splenic cysts with non-serous contents.
Assuntos
Cistos , Laparoscopia , Esplenopatias , Humanos , Feminino , Laparoscopia/métodos , Cistos/cirurgia , Adulto , Esplenopatias/cirurgia , Esplenopatias/diagnóstico por imagemRESUMO
Hydatidosis is a zoonosis due to the development of the larval form of Echinococcus granulosus in humans. This disease is very frequent in many countries of North Africa such as Morocco. The most frequent locations of hydatid cysts are the liver (75%) and the lungs (15.4%). Splenic hydatid cyst occurs in only 5.1% of cases. The diagnosis remains challenging and is made upon a hundle of clinical, radiological, biological, and histological arguments. In this paper, we report a case of spleen-preserving surgery for a splenic hydatid cyst to suggest the best management of these hydatid cysts and avoid recurrences.
Assuntos
Equinococose , Esplenopatias , Humanos , Equinococose/cirurgia , Equinococose/diagnóstico , Esplenopatias/cirurgia , Esplenopatias/parasitologia , Esplenopatias/diagnóstico , Marrocos , Masculino , Echinococcus granulosus/isolamento & purificação , Adulto , Baço/parasitologia , Baço/patologia , Baço/cirurgia , Feminino , AnimaisRESUMO
RATIONALE: Sclerosing angiomatoid nodular transformation (SANT) of the spleen is an uncommon benign vascular lesion with an obscure etiology. It predominantly affects middle-aged women and presents with nonspecific clinical signs, making preoperative diagnosis challenging. The definitive diagnosis of SANT relies on pathological examination following splenectomy. This study aims to contribute to the understanding of SANT by presenting a case series and reviewing the literature to highlight the clinical presentation, diagnostic challenges, and treatment outcomes. PATIENT CONCERNS: In this retrospective study, we analyzed the clinical data of 3 patients with confirmed SANT admitted from November 2013 to October 2023. The cases include a 25-year-old male, a 15-year-old female, and a 39-year-old male, each with a splenic mass. DIAGNOSES AND INTERVENTIONS: All of the three cases were treated by laparoscopic splenectomy (LS). Pathological examination confirmed SANT in all cases. OUTCOMES: No recurrence or metastasis was observed during a 10-year follow-up for the first 2 cases, and the third case showed no abnormalities at 2 months postoperatively. Despite its rarity, SANT is a significant condition due to its potential for misdiagnosis and the importance of distinguishing it from malignant lesions. The study underscores the utility of LS as a safe and effective treatment option. LESSONS: SANT is a rare benign tumor of the spleen, and the preoperative diagnosis of whom is challenging. LS is a safe and effective treatment for SANT, with satisfactory surgical outcomes and favorable long-term prognosis on follow-up. The study contributes to the limited body of research on this rare condition and calls for larger studies to validate these findings and improve clinical management.
Assuntos
Esplenectomia , Neoplasias Esplênicas , Humanos , Masculino , Adulto , Feminino , Esplenectomia/métodos , Adolescente , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/cirurgia , Neoplasias Esplênicas/diagnóstico , Baço/patologia , Histiocitoma Fibroso Benigno/patologia , Histiocitoma Fibroso Benigno/cirurgia , Histiocitoma Fibroso Benigno/diagnóstico , Estudos Retrospectivos , Laparoscopia/métodos , Diagnóstico Diferencial , Esplenopatias/cirurgia , Esplenopatias/patologia , Esplenopatias/diagnósticoRESUMO
Dogs that had splenectomy are predisposed to fatal thrombotic conditions, and thrombocytosis is a risk factor for post-splenectomy hypercoagulability. However, in veterinary medicine, there are no specific therapeutic approaches for managing this hypercoagulability. This study aimed to determine the preventive effect of clopidogrel on post-operative hypercoagulability during the first 2 weeks post-splenectomy in dogs with splenic masses. This study included 12 dogs that had splenectomy. Seven dogs received no treatment (group A), and five were treated with clopidogrel (group B). Clopidogrel was loaded at 10 mg/kg on day 2 and continued at 2 mg/kg until day 14. Blood samples were collected on the day of surgery and 2, 7, and 14 days after splenectomy in both groups. In group B, thromboelastography (TEG) was performed on the same days. In group A, there was significant elevation of platelet counts on days 7 (p = 0.007) and 14 (p = 0.001) compared to day 0. In group B, the platelet counts were significantly elevated on day 7 (p = 0.032) but no significant difference was found on day 14 compared to day 0. Platelet counts on day 14 were significantly higher in group A than in group B (p = 0.03). The lower platelet counts were correlated with alterations in TEG parameters, and no significant differences were found in the K and α-angle values at all postoperative assessment points compared to day 0. Our study suggests that clopidogrel may reduce post-operative thrombocytosis and hypercoagulability in dogs that undergo splenectomy for splenic masses.
Assuntos
Clopidogrel , Doenças do Cão , Inibidores da Agregação Plaquetária , Esplenectomia , Tromboelastografia , Trombofilia , Animais , Cães , Esplenectomia/veterinária , Esplenectomia/efeitos adversos , Clopidogrel/uso terapêutico , Doenças do Cão/sangue , Doenças do Cão/cirurgia , Doenças do Cão/tratamento farmacológico , Contagem de Plaquetas/veterinária , Feminino , Masculino , Trombofilia/veterinária , Trombofilia/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Inibidores da Agregação Plaquetária/farmacologia , Tromboelastografia/veterinária , Complicações Pós-Operatórias/veterinária , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Esplênicas/veterinária , Neoplasias Esplênicas/cirurgia , Neoplasias Esplênicas/sangue , Esplenopatias/veterinária , Esplenopatias/cirurgia , Esplenopatias/sangue , Trombocitose/veterináriaAssuntos
Anormalidade Torcional , Baço Flutuante , Humanos , Baço Flutuante/cirurgia , Baço Flutuante/complicações , Baço Flutuante/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Anormalidade Torcional/diagnóstico , Criança , Feminino , Masculino , Baço/anormalidades , Baço/diagnóstico por imagem , Esplenopatias/cirurgia , Esplenopatias/diagnóstico por imagemRESUMO
Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The isolated extrapulmonary form is rare. We report the case of hepatosplenic sarcoidosis in a 29-year-old female patient.It is a patient with no notable medical history, who was seen in consultation for repeated epistaxis. Clinical examination noted nodular hepatomegaly associated with signs of portal hypertension and splenomegaly. Sedimentation rate, alkaline phosphatase, serum angiotensin converting enzyme, aminotransferases were high. Histological examination of the spleen and liver biopsy noted granulomatous inflammatory infiltration without cancerous lesion or tonsil stones.This picture is comparable with sarcoidosis, despite the absence of PET scans. The main challenge remains the differential diagnosis with other granulomatoses. Corticosteroid therapy is the first-line treatment, and after splenectomy the patient has achieved clinical and biological stability.
Assuntos
Hepatopatias , Sarcoidose , Esplenopatias , Humanos , Sarcoidose/patologia , Sarcoidose/diagnóstico , Feminino , Adulto , Esplenopatias/patologia , Esplenopatias/cirurgia , Esplenopatias/diagnóstico , Congo , Hepatopatias/patologia , Hepatopatias/diagnóstico , Hospitais UniversitáriosRESUMO
Background: Splenectomy has been performed for various indications from haematological diseases to benign cysts and tumours, and for splenic traumatic injuries. However, there has been a steady decline in splenectomies in the last 20 years. The aim of this study is to establish the reasons behind this decline in splenectomy and to analyse them based on indication, type of splenectomy, and manner of approach (open, laparoscopic or robotic). Material and Methods: This is a retrospective study of a single centre experience of all the splenectomies, both total and partial, performed in the Department of General Surgery of Fundeni Clinical Institute (Bucharest) between 2002 and 2023. Only surgeries for primary splenic diseases were selected, splenic resections as part of other major operations were not included. Results: Between 2002 and 2023, 876 splenectomies were performed in the Department of General Surgery of Fundeni Clinical Institute (Bucharest). Most splenectomies (n=245) were performed for immune thrombocytopenic purpura (ITP), followed by benign tumours and cysts (n=136), lymphoma (n=119), hypersplenism due to cirrhosis (n=107) and microspherocytosis (n=95). Other indications included myelodysplastic syndrome (n=39), trauma (n=35), thalassemia (n=22), leukaemia (n=18) and also there were 60 splenectomies that were performed for hypersplenism of unknown cause. There were 795 total splenectomies (TS) and 81 partial splenectomies (PS). There was a decline in the number of splenectomies both TS and PS for all these indications, most notably in the case of ITP, microspherocytosis and hypersplenism due to cirrhosis with no splenectomies performed for these indications since 2020. Conclusion: With the development of new lines of treatment, advances in interventional radiology and in surgery with the spleen parenchyma sparing options, the need for total splenectomy has been greatly reduced which is reflected in the decline in the number of splenectomies performed in the last 20 years in our clinic.
Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Esplenectomia , Esplenopatias , Humanos , Esplenectomia/métodos , Esplenectomia/estatística & dados numéricos , Estudos Retrospectivos , Laparoscopia/métodos , Romênia/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento , Esplenopatias/cirurgia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Púrpura Trombocitopênica Idiopática/cirurgia , Idoso , Linfoma/cirurgia , Hiperesplenismo/cirurgia , Hiperesplenismo/etiologia , Talassemia/cirurgia , Cistos/cirurgiaRESUMO
BACKGROUND: A colosplenic fistula (CsF) is an extremely rare complication. Its diagnosis and management remain poorly understood, owing to its infrequent incidence. Our objective was to systematically review the etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide aid if it is to be encountered. METHODS: A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected. RESULTS: Thirty patients with CsFs were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and 12 patients were initially managed nonoperatively. However, 11 of the nonoperative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality. CONCLUSIONS: Our review of 30 cases worldwide is the largest in literature. CsFs are predominantly complications of neoplastic processes. CsF may be successfully and safely treated with splenectomy and resection of the affected colon, with a low rate of postoperative complications.
Assuntos
Esplenopatias , Humanos , Esplenopatias/cirurgia , Esplenopatias/diagnóstico , Esplenopatias/terapia , Masculino , Feminino , Pessoa de Meia-Idade , Fístula Intestinal/cirurgia , Fístula Intestinal/diagnóstico , Esplenectomia , Adulto , Idoso , Complicações Pós-Operatórias , Doenças do Colo/cirurgia , Doenças do Colo/diagnóstico , Doenças do Colo/terapia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Splenic abscess is a serious complication associated with infective endocarditis. There is still contradicting evidence regarding the optimal treatment pathway including timing of valve intervention and the approach for managing splenic foci. CASE PRESENTATION: We present a case of a hybrid staged approach in which we successfully performed a laparoscopic splenectomy following percutaneous abscess drainage and a delayed aortic valve replacement. CONCLUSIONS: A multidisciplinary teamwork is fundamental in providing optimal care for patients with distant complications associated with infective endocarditis. Our hybrid approach seems safe and feasible.
Assuntos
Embolia , Endocardite Bacteriana , Endocardite , Esplenopatias , Humanos , Esplenopatias/cirurgia , Esplenopatias/complicações , Abscesso/etiologia , Abscesso/cirurgia , Valva Aórtica/cirurgia , Endocardite/complicações , Endocardite/cirurgia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/cirurgia , Embolia/complicaçõesRESUMO
BACKGROUND: Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed. CASE PRESENTATION: A 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days. CONCLUSION: Splenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.
Assuntos
Cistos Ovarianos , Esplenopatias , Baço Flutuante , Feminino , Humanos , Baço Flutuante/diagnóstico , Baço Flutuante/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Esplenopatias/cirurgia , Esplenomegalia , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/cirurgiaRESUMO
Xanthogranulomatous inflammation is a chronic inflammatory reaction microscopically characterized by aggregation of foamy histiocytes, fibrous tissue, and infiltration of various inflammatory cells. In contrast to xanthogranulomatous inflammation in the gallbladder or kidney, xanthogranulomatous pancreatitis is rare. We herein present a case of xanthogranulomatous pancreatitis in a patient who underwent distal pancreatectomy with splenectomy under preoperative suspicion of a pancreatic pseudocyst or pancreatic tumor. A 77-year-old woman with a 1 month history of epigastric pain, anorexia, and general fatigue was admitted to our hospital. Contrast-enhanced computed tomography revealed a cystic mass with ill-defined margins at the pancreatic tail together with a splenic abscess. Contrast-enhanced endoscopic ultrasound detected a hyperechoic cystic lesion at the tail of the pancreas with heterogeneous internal echogenicity, and part of the intra-cystic content was enhanced by the contrast agent. Endoscopic retrograde cholangiopancreatography showed a cystic lesion at the tail of the pancreas that continued into the main pancreatic duct, and the main pancreatic duct was slightly narrowed downstream of the cystic lesion. Pancreatic juice cytology revealed suspicious cells, leading to the possibility of intraductal papillary mucinous carcinoma. Distal pancreatectomy with splenectomy was performed, and the histopathological diagnosis was xanthogranulomatous pancreatitis with no malignant findings.
Assuntos
Pancreatectomia , Pancreatite , Esplenopatias , Tomografia Computadorizada por Raios X , Xantomatose , Humanos , Idoso , Feminino , Esplenopatias/cirurgia , Esplenopatias/diagnóstico por imagem , Esplenopatias/patologia , Esplenopatias/complicações , Xantomatose/cirurgia , Xantomatose/complicações , Xantomatose/patologia , Pancreatite/cirurgia , Pancreatite/complicações , Abscesso/cirurgia , Abscesso/diagnóstico por imagem , Esplenectomia , Granuloma/cirurgia , Granuloma/patologia , Granuloma/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica , EndossonografiaRESUMO
Hepatosplenic schistosomiasis is a complex clinical condition caused by the complications of chronic infection with Schistosoma species that cause intestinal schistosomiasis. Hepatosplenic schistosomiasis derives from the fibrotic reaction stimulated around parasite eggs that are transported by the mesenteric circulation to the liver, causing periportal fibrosis. Portal hypertension and variceal gastrointestinal bleeding are major complications of hepatosplenic schistosomiasis. The clinical management of hepatosplenic schistosomiasis is not standardised and a parameter that could guide clinical decision making has not yet been identified. Transjugular intrahepatic portosystemic shunt (TIPS) appears promising for use in hepatosplenic schistosomiasis but is still reported in very few patients. In this Grand Round, we report one patient with hepatosplenic schistosomiasis treated with TIPS, which resulted in regression of oesophageal varices but had to be followed by splenectomy due to persisting severe splenomegaly and thrombocytopenia. We summarise the main challenges in the clinical management of this patient with hepatosplenic schistosomiasis, highlight results of a scoping review of the literature, and evaluate the use of of TIPS in patients with early hepatosplenic schistosomiasis, to improve the prognosis.
Assuntos
Derivação Portossistêmica Transjugular Intra-Hepática , Esquistossomose , Esplenectomia , Esplenopatias , Humanos , Esquistossomose/complicações , Esquistossomose/cirurgia , Esplenopatias/cirurgia , Esplenopatias/parasitologia , Masculino , Esplenomegalia/cirurgia , Esplenomegalia/etiologia , Esplenomegalia/parasitologia , Adulto , Hipertensão Portal/cirurgia , Hipertensão Portal/etiologia , Hepatopatias Parasitárias/cirurgia , Feminino , Resultado do TratamentoRESUMO
Background: Splenic sclerosing angiomatoid nodular transformation (SANT) is a rare benign nodular lesion in the red medulla of the spleen. In the past, SANT has not been consistently recognized as the name for this condition and was often misdiagnosed for other conditions. In recent years, SANT has been acknowledged by most scholars as multiple reports have been published. Aim: To assess the clinicopathological features of SANT to identify the histological characteristics of SANT to improve diagnosis and clinical treatment. Materials and Methods: We assessed 25 cases of SANT diagnosed at Zhongshan Hospital affiliated with Fudan University from September 2014 to October 2021, including 14 men and 11 women, aged 24-62 years old. Results: Fourteen cases were complicated with benign tumors of the liver, pancreas, kidney, uterus, and prostate. One case was complicated with renal clear cell carcinoma, and one was complicated with hepatocellular carcinoma. The gross neoplasm is multinodular and well defined. Histologically, angiomatoid nodules are composed of fattened, round, or irregular blood vessels, with or without red blood cells in the lumen, with unequal red blood cell extravasation, and fibrocytes around the nodules. The hemangiomatous nodules were positive for CD31 and CD34, while the vascular wall smooth muscle cells and fibrocytes around the nodules were positive for SMA. Conclusion: The diagnosis of SANT requires a combination of immunohistochemical and histological features, and early splenectomy is crucial for treatment.
Assuntos
Hemangioma , Histiocitoma Fibroso Benigno , Esplenopatias , Neoplasias Esplênicas , Masculino , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Esplenopatias/diagnóstico , Esplenopatias/cirurgia , Esplenopatias/patologia , Esplenectomia , Hemangioma/diagnóstico , Hemangioma/patologia , Neoplasias Esplênicas/diagnóstico , Neoplasias Esplênicas/cirurgia , Neoplasias Esplênicas/patologiaRESUMO
A 48-year-old woman underwent transcatheter arterial embolization (TAE) for a splenic artery aneurysm, which resulted in a partial splenic infarction in the middle lobe. Five years after TAE, a 20-mm diameter mass in the noninfarcted area of the spleen was detected on imaging, which grew to 25 mm in diameter after 6 months. MRI after gadolinium administration showed a 35 × 34 mm mass within the superior pole and 15 × 12 mm mass within the inferior pole. The patient underwent laparoscopic splenectomy and had an uneventful postoperative recovery. No evidence of recurrence was observed during the 2-year follow-up period after surgery. The mass was pathologically confirmed to be sclerosing angiomatoid nodular transformation (SANT) of the spleen. While some studies hypothesize that SANT is a response to vascular injury or trauma, to the best of our knowledge, there have been no previous reports of SANT occurring after procedures directly affecting splenic blood flow. Additionally, multifocal SANTs are reported to be very rare, accounting for only 4.7% of all reported SANTs of the spleen. We highlight a rare course of SANT of the spleen and discuss the possible relationship between blood flow abnormalities and the appearance of SANT.
Assuntos
Aneurisma , Embolização Terapêutica , Gastroenteropatias , Esplenopatias , Infarto do Baço , Neoplasias Esplênicas , Feminino , Humanos , Pessoa de Meia-Idade , Esplenopatias/cirurgia , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Infarto do Baço/terapia , Esclerose , Artéria Esplênica/diagnóstico por imagem , Esplenectomia/métodos , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/cirurgia , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/diagnóstico por imagem , Neoplasias Esplênicas/cirurgiaRESUMO
BACKGROUND: Splenic cysts are quite rare and asymptomatic. They may result from infection by a parasite, especially Echinococcus granulosus (hydatid cyst), or from non-parasitic causes. Since primary splenic cysts are not common, simple cysts can be misdiagnosed with a hydatid cyst in endemic areas. CASE PRESENTATION: We reported a 14-year-old Iranian girl initially presented with a vague abdominal pain, which progressed to left shoulder pain, fullness, early satiety, and shortness of breath and remained undiagnosed for 7 months despite seeking medical attention. Finally, imaging revealed a massive splenic cyst measuring 220 mm × 150 mm × 160 mm raising concern for a hydatid cyst due to regional endemicity. Consequently, the patient underwent total splenectomy. However, histopathological examination surprisingly revealed a simple non-parasitic cyst. CONCLUSIONS: Detecting rare simple spleen cysts requires early ultrasonography (US) and careful reassessment of diagnoses for non-responsive or worsening symptoms. Distinguishing them from splenic hydatidosis, especially in endemic areas, demands thorough paraclinical evaluations and patient history regarding potential parasitic exposure. While total splenectomy is the primary treatment for these huge cysts, the optimal surgical approach should be tailored case by case. These insights emphasize a comprehensive diagnostic approach to enhance accuracy and optimize patient care for these uncommon cysts.
Assuntos
Cistos , Equinococose , Parasitos , Esplenopatias , Feminino , Animais , Humanos , Adolescente , Irã (Geográfico) , Esplenopatias/diagnóstico por imagem , Esplenopatias/cirurgia , Cistos/diagnóstico por imagem , Cistos/cirurgia , Equinococose/diagnóstico por imagem , Equinococose/cirurgiaRESUMO
BACKGROUND Splenic cysts are classified as either parasitic or non-parasitic cysts, with both types sharing similarities in their clinical presentation and imaging findings. Most splenic cysts are of parasitic origin, while non-parasitic splenic cysts are less common. Splenic epidermoid cysts (SECs) are a rare subtype of non-parasitic cysts and compromise only around 10% of them. CASE REPORT In this paper we present a case of 22-year-old man with no significant past clinical history, who presented with non-specific, vague symptoms, including persistent left upper-quadrant pain and discomfort for the last 2 years. A physical examination and extensive laboratory tests were inconclusive. Subsequently, the patient underwent multiple imaging studies including ultrasonography and computed tomography (CT) scan of the abdomen. His ultrasonographic findings were consistent with the diagnosis of hydatid cyst, which was further emphasized by its frequent occurrence in clinical practice, as our country is considered an endemic region. In light of this, he underwent laparoscopic splenectomy following percutaneous cyst drainage. The consequent histopathological examination revealed the diagnosis of splenic epidermoid cysts. CONCLUSIONS When encountering splenic cysts in regions where parasitic infections are endemic, special attention is needed, as physical examination, laboratory tests, and imaging studies alone are insufficient to differentiate among the types of cysts. Histopathological examination remains the diagnostic tool of choice, particularly when imaging findings are inconclusive. Splenectomy, with either a laparoscopic or open approach, is the treatment of choice for splenic cysts to prevent recurrence as well as other potential catastrophic complications.
Assuntos
Equinococose , Cisto Epidérmico , Esplenopatias , Humanos , Masculino , Adulto Jovem , Erros de Diagnóstico , Equinococose/diagnóstico , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/cirurgia , Cisto Epidérmico/patologia , Esplenopatias/diagnóstico , Esplenopatias/cirurgiaRESUMO
BACKGROUND: Accessory splenic tissue is a commonly encountered phenomenon in medical literature. Typically, these accessory spleens are found in close proximity to the main spleen, either in the hilum or within the surrounding ligaments. Nevertheless, it is noteworthy that they can also be located in unusual sites such as the jejunum wall, mesentery, pelvis, and, exceptionally rarely, the scrotum. The first documented case of accessory splenic tissue in the scrotum was reported by Sneath in 1913 and is associated with a rare congenital anomaly called splenogonadal fusion. This report describes an infant who presented with a scrotal mass noted by his mother and after examination, investigations, and surgical exploration, it was revealed to be splenogonadal fusion. CASE DESCRIPTION: An 8-month-old Caucasian male patient presented with a mass in the left testicle and bluish discoloration of the scrotum, which had been incidentally noticed in the previous 2 months. The general physical examination was unremarkable. Other than a palpable scrotal mass that was related to the upper pole of the testis, the rest of examination was unremarkable. Imaging revealed that this mass originated from the tail of the epididymis without infiltrating the testis and tumor markers were normal. On inguinal exploration, a reddish brown 2 × 2 cm mass was found attached to the upper pole and was completely excised without causing any harm to the testis, vessels, or epididymis. Histopathological evaluation confirmed the presence of intratesticular ectopic splenic tissue. CONCLUSION: Although uncommon, splenogonadal fusion can be included in the differential diagnosis of a testicular swelling. Accurate diagnosis allows for appropriate treatment planning which helps to avoid unnecessary radical orchiectomy, which can have a significant impact on the patient's reproductive and psychological wellbeing.