Intrapancreatic accessory spleen: a diagnostic dilemma.

ABSTRACT

BACKGROUND: As intrapancreatic accessory spleen (IPAS) is rarely encountered during clinical practice, the aim of this review was to summarize the epidemiologic features, the diagnosis and treatment of IPAS. METHODS: MEDLINE and EMBASE were searched for articles reporting on IPAS. Categorical variables were reported as frequency and percentage. Continuous variables were reported as median (range). RESULTS: A total of 105 patients were included, of which 73% were detected incidentally. The male/female ratio was 1.23. The size of IPAS in patients who had previously undergone splenectomy was larger than that of patients without prior splenectomy (2.5 cm vs 1.5 cm; p = 0.020). No preoperative examination was able to make a definite diagnosis for all IPASs. More than half of the patients (55%) received surgical treatment, most of which (87%) were suspected as pancreatic neuroendocrine tumors (p-net) preoperatively. CONCLUSIONS: Although rare, IPAS should be considered in the differential of patients with suspected incidental p-net, especially if there has been a past history of splenectomy. Preoperative diagnosis is important as unnecessary surgery can be avoided. As it is difficult to make a definite diagnosis of IPAS by one single examination, multiple techniques may be required.