[Post-traumatic thoracic splenosis]. / Klinicheskii sluchai posttravmaticheskogo grudnogo splenoza.

Splenosis is a rare disease and defined as spleen tissue autotransplantation following spleen rupture and subsequent splenectomy in most cases. The authors report ectopic splenic tissue in pleural cavity diagnosed in 31 years after blunt thoracoabdominal trauma.

Endoscopic full-thickness resection of gastric ectopic splenic nodules.

BACKGROUND: Ectopic spleen is extremely rare. Most cases are congenital, acquired ectopic spleen may be a consequence of surgery or trauma to the spleen. The ectopic spleen in the gastric wall we reported is even rarer. CASE PRESENTATION: We report a 41-year-old female patient, with a past history of splenectomy, who presented with heartburn. Gastroscopy revealed a swelling in the fundus in the stomach. Ultrasonography and computed tomographic examination suggested the possibility of gastrointestinal stromal tumor. We performed endoscopic resection of the mass. Pathological examination of the resected mass showed ectopic spleen. CONCLUSION: When a patient with a history of splenectomy presents with a gastric submucosal tumor, ectopic spleen should also be considered in the differential diagnoses. And minimally invasive endoscopic treatment can achieve the purpose of diagnosis and treatment for unobvious submucosal tumors.

Pancreatic Incidentalomas: A Management Algorithm for Identifying Ectopic Spleens.

BACKGROUND: Identification of incidental pancreatic lesions is increasing because of advancements in imaging. Diagnosis remains a challenge for clinicians, with intrapancreatic accessory spleens (IPAS) posing a unique dilemma. IPAS are frequently resected because of inability to exclude alternate diagnoses, subjecting patients to unnecessary risk. The purpose of this study was to examine our institutional experience with IPAS and develop a multidisciplinary algorithm to improve preoperative diagnosis. MATERIALS AND METHODS: Patients who underwent a distal pancreatectomy at a single institution from 2005 to 2018 were identified from a prospectively maintained database. Examination of final pathology for a diagnosis of IPAS yielded the final cohort. Demographics, preoperative workup, and operative course were reviewed and analyzed. A diagnostic algorithm was composed based on the consensus of a panel of expert pancreatic surgeons, a radiologist, and a pathologist. RESULTS: Ten patients of 303 patients who underwent a distal pancreatectomy were identified with a final pathology of IPAS. The average age was 54 y, 80% were white, and 60% were male. Lesions ranged in size from 7 mm to 5.1 cm in largest diameter (mean 2.2 cm). Lesions were described as round, well-marginated, and enhancing masses within the pancreatic tail. Preoperative workup was variable in terms of imaging and laboratory testing. Diagnostic workups were examined and combined with multidisciplinary input to create a diagnostic algorithm. CONCLUSIONS: Incidental pancreatic lesions like IPAS remain a diagnostic challenge for clinicians. Employing a diagnostic algorithm as proposed may aid in the distinction of malignant and premalignant pathology and prevent unwarranted pancreatic resections.

Ectopic spleen mimicking hepatocellular carcinoma in the late post-operative period of bariatric surgery.

An ectopic spleen occurs with less than 600 cases reported and has a large series of splenectomies less than 0.3%. Its highest prevalence occurs between 20 and 40 years of age, being more frequent in female patients. To present an original case report on the occurrence of ectopic spleen, mimicking hepatocellular carcinoma (HCC) after bariatric surgery. Occurrence of migratory spleen after late bariatric surgery, mimicking an HCC discovered in a routine evaluation. JCA patient, male, 66 years old, previously with sleep apnea, hypertensive and diabetic patients on medication regularly, who weighed 112.8 kg, with a BMI of 43.4 kg / m2. After 2 years of by-pass, a routine evaluation identified hepatobiliary surface on hepatic ultrasound performing MRI imaging suggestive of HCC. The team opted for a new laparoscopy with the possibility of cavity inventory beyond the biopsy of the tumor lesion already identified, to track intra-abdominal metastases and to review anatomy. The operation revealed that the suggestive lesion was subcapsular implanted only in the falciform and hepatic surface in segment amenable to total resection. The anatomopathological results of the lesions were described as congenital splenic cells compatible with ectopic spleen. The emergence of the ectopic spleen after laparoscopic bypass has not been reported so far because it is a non-traumatic surgery. The lesion in question had a benign behavior, with hepatic subcapsular implantation restricted to the falciform ligament, capable of total resection. Patient evolved well following follow up with gastroenterologist.

Laparoscopic splenopexy for wandering spleen, a video demonstration of technique by encircling the spleen with polyglactin 910 woven mesh.

BACKGROUND: Wandering spleen is a rare clinical entity caused by absence of the spleen's peritoneal attachments, allowing the spleen to move freely within the peritoneal cavity [1]. This disease is most commonly seen in children and young women [1, 2]. Affected individuals are predisposed to complications including splenic torsion, splenic infarction, and pancreatic necrosis [3, 4]. Patients may present with constipation, an abdominal mass, swelling, or acute abdominal pain if splenic torsion has occurred [4]. Wandering spleen is difficult to diagnose without imaging, as symptoms are non-specific or may be absent. Imaging studies to confirm the diagnosis may include computed tomography (CT) scan or duplex ultrasonography [5]. Definitive management of a wandering spleen is primarily surgical [2]. Splenectomy is the preferred treatment in patients who present with an acute splenic infarction [2, 6]. Splenopexy, however, is first line treatment for patients with a non-infarcted wandering spleen [2, 7, 8]. CASE PRESENTATION: In this video, we present a case of an 11 year old male with a symptomatic wandering spleen who was treated at our institution with laparoscopic splenopexy. The patient had a history of arthrogryposis multiplex congenita and presented with recurrent, episodic abdominal pain, nausea, and vomiting. The diagnosis was confirmed by CT scan which demonstrated the spleen in the right lower quadrant. We performed laparoscopic splenopexy by encircling the spleen with polyglactin 910 woven mesh and attaching the mesh to the left lateral abdominal wall with absorbable tacks. DISCUSSION: Our surgical technique for splenopexy was successful and the patient returned home on postoperative day four. No significant complications occurred. This video demonstrates this technique and highlights the key steps. Splenopexy by encircling the spleen with polyglactin 910 mesh is feasible, preserves splenic function, and can be performed with standard laparoscopic equipment. Tacks or transfascial sutures are a potential option for securing mesh.

IMAGING DIAGNOSIS-ECTOPIC SPLEEN MIMICKING HEPATIC TUMOR WITH INTRA-ABDOMINAL METASTASES INVESTIGATED VIA TRIPLE-PHASE HELICAL COMPUTED TOMOGRAPHY IN A DOG.

A 10-year-old castrated male miniature dachshund was presented with an abdominal mass. The dog had a history of splenectomy. Triple-phase helical computed tomography was utilized, revealing a hepatic mass and multiple intra-abdominal solid masses. In triple-phase helical computed tomography the images, hepatic mass and two of four intra-abdominal masses were heterogenous in all phases. Therefore, we diagnosed a malignant hepatic tumor and presumed intra-abdominal metastases. The masses were surgically removed and were histologically composed of normal spleen tissues, findings which were consistent with ectopic spleen.

Wandering spleen in a postpartum female: a case report.

Introduction and importance: Wandering spleen (WS) is a rare condition that occurs when the spleen is not in its normal anatomical location, but in the abdominal or pelvic cavity. The mechanism of this condition may be due to dysfunction of ligaments that fixate the spleen in its position. Female hormonal alterations during pregnancy and other unknown causes in children may also play role in an ectopic spleen. Case presentation: The authors report a case of a 34-year-old woman who presented to the emergency department with intermittent abdominal pain that persisted after childbirth without other symptoms. Clinical discussion: Clinically the symptoms are varied and abdominal pain is the most common presentation. Radiological investigation of WS include ultrasound, MRI, and CT, which is the most preferred tool. Treatments after the diagnosis include splenectomy or splenopexy either through laparoscopy or laparotomy. Conclusion: Physicians should include ectopic spleen as a differential diagnosis in a multiparous woman with the presentation of acute or chronic abdominal pain.

The imaging features of ectopic spleen: which modality is more consistent? A cases series report and literature reviews.

Ectopic spleen (ES) is a rare condition. It is difficult to diagnose with conventional imaging modalities. In this case series, we presented the imaging features of three misdiagnosed ES cases in our hospital and previously reported cases to compare the consistency of enhancement patterns among different imaging modalities with varied phases. Finally, 22 cases were reviewed. We determined that variable arterial phase enhancement and persistent enhancement throughout the portal and delayed phases are present in contrast-enhanced ultrasound (CEUS) imaging of the ES and found the arterial phase of CEUS had the highest consistency compared with computerized tomography (CT) and magnetic resonance imaging (MRI).

Atypically located accessory splenic hemangiosarcoma in a Dog: Diagnostic value of triple-phase computed tomography.

A 10-year-old Cocker spaniel presented with lethargy. Triple-phase computed tomography was obtained with a contrast test bolus at the level of porta hepatis, which revealed a right lower abdominal mass. The mass was not connected to other abdominal organs; however, a linear structure was observed connecting the splenic hilum to the mass, which was suspected to be the feeding vessel. The arterial phase image was obtained again with a contrast bolus at the level of the celiac artery. A prominent contrast-enhanced feeding artery originating from the splenic artery to the mass was observed. Histopathology confirmed an accessory splenic hemangiosarcoma.

Torsion of a wandering spleen in a pregnant patient presented with acute abdomen: A case report.

INTRODUCTION AND IMPORTANCE: Wandering spleen may result in torsion or splenomegaly, which causes symptoms such as intestinal obstruction, nausea, vomiting, and swelling in the abdomen. There are few reports of wandering spleen torsion in pregnant mothers. The diagnosis and presentation of splenic torsion is variable and challenging during pregnancy. Herein, we present a case of torsion of a wandering spleen in a 30-year-old pregnant patient. CASE PRESENTATION: A 30-year-old female presented with a sudden onset of abdominal pain of three days' duration. There was lower abdominal mass and tenderness. Intraoperative findings revealed enlarged spleen located over the lower abdominal cavity with six times clockwise rotation of the splenic pedicle over itself. A splenectomy was performed. The patient was discharged on the 7th postoperative day and had an uneventful postoperative recovery. CLINICAL DISCUSSION: Patient presentation could be asymptomatic, chronic left abdominal pain or symptoms and signs of complication. The most common complication of wandering spleen is torsion (Abell, n.d.). Splenic torsion is evidenced by mucosal bleeding, hematemesis, anemia or thrombocytopenia in our patient platelets level was 111,000 cells/µl which suggests vascular thrombosis. The other peculiarity during pregnancy is torsion of the spleen have higher mortality reaching up to 41 % (Lewis and Wolskel, 1962) which may be from delay in diagnosis or misdiagnosis. CONCLUSION: There is high mortality associated with splenic torsion in pregnant patient reported in the literature. One of the explanations is misdiagnosis and delay in diagnosis of torsion of a wandering spleen in a pregnant patient.

Accessory Spleen Mimicking an Intrahepatic Neoplasm: A Rare Case Report.

Accessory spleen and splenosis are two types of ectopic spleen. An accessory spleen can be found in various sites in the abdomen, but an intrahepatic accessory spleen is very rare though many case reports of intrahepatic splenosis are available. This case report presents the incidental diagnosis of accessory spleen in the liver of a 57-year-old male while undergoing laparoscopic diaphragmatic repair. The patient had a history of splenectomy 27 years ago for hereditary spherocytosis, but his routine haemogram did not show any features of the ectopic splenic function. Intraoperatively, a mass was suspected in the liver and was resected. Histopathology revealed an accessory spleen with well-preserved red and white pulp architecture. Though a history of splenectomy suggested a diagnosis of splenosis, a well-encapsulated and preserved splenic architecture confirmed the diagnosis of accessory spleen. Accessory spleen or splenosis can be diagnosed radiologically using Tc-99m-labeled heat-denatured red blood cells (HRBC) and Tc-99m sulfur colloid scans, but the gold standard is histopathological examination. Ectopic spleen is mostly asymptomatic but usually results in unnecessary surgeries as it is difficult to differentiate from benign or malignant tumors. Thus, a high degree of suspicion and awareness is necessary for early and prompt diagnosis.

Wandering spleen with torsion and infarction: A case report.

Wandering spleen, also known as ectopic spleen, is a rare condition in which the spleen's anatomical location is other than its fixed position in the abdomen's left upper quadrant. The cause of such an abnormality could be due to congenital or acquired factors, which could ultimately lead to torsion and splenic infarct. Given the nonspecific clinical symptoms and the potential complications associated with wandering spleen, computed tomography scans provide a crucial means for proper diagnosis. In this article, we report the case of a 16-year-old female with a diagnosis of wandering spleen with torsion and splenic infarct.

Accessory Spleen Masquerading as an Intrapancreatic Tumor: A Case Report.

The finding of splenic tissue within the pancreas, also known as splenosis or intrapancreatic accessory spleen (IPAS), is a relatively uncommon condition that presents as an intrapancreatic mass. The discovery of an intrapancreatic mass often prompts a thorough diagnostic workup for a primary pancreatic malignancy, often exposing patients to unnecessary risks associated with invasive testing and even surgery. The benign, asymptomatic nature of this finding places emphasis on utilizing non-invasive techniques for confirmation of the diagnosis, reducing risks of morbidity and mortality in this patient population. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) will display near-identical signal intensities (SI) between the spleen and the intrapancreatic mass, as well as identical contrast-enhancement patterns. Nuclear medicine evaluation with Tc-99m heat-damaged red blood cells (HDRBCs) is often used as a confirmatory test and allows for differentiation from malignancies.

Ectopic Intrathoracic Kidney Associated with Ipsilateral Ectopic Spleen and Diaphragmatic Hernia in a Pediatric Patient: A Case Report.

Background: Intrathoracic kidney is the rarest form of an ectopic kidney that is usually accompanied by left congenital diaphragmatic hernia (CDH) (Bochdalek hernia), the association of which with other anomalies is rare. Case Presentation: Herein, we describe a case with a diagnosis of an intrathoracic kidney associated with the ectopic spleen and diaphragmatic hernia diagnosed during imaging studies for urinary tract infections (UTIs). This study reports an 11-month-old male case with a history of CDH and several episodes of UTIs. A kidney ultrasound revealed that the left kidney and spleen were located in the thoracic cavity. Despite intrathoracic lying of the left kidney, there was no vesicoureteral reflux. Technetium-99m dimercaptosuccinic acid scan reported a highly positioned left kidney . Conclusion: With the consideration of a pediatric literature review among patients with intrathoracic ectopic kidney, our case was special and notable since it was the first neonate who had an association of intrathoracic spleen and kidney in the same side with a delayed diagnosis. The main point of this case was that radiologists should consider thoracic kidney a differential diagnosis of unilateral renal agenesis when there is a history of diaphragmatic hernia.

Post-traumatic intrathoracic splenosis and role of Tc-99m Sulfur colloid scintigraphy in confirmation.

Splenosis is acquired ectopic splenic tissue, usually a sequela of trauma. Its imaging appearance is can be deceiving, and at unusual locations may be mistaken for an alternate cause mass lesion. We present one such unusual case of splenosis in a 53 year-old man with history of heart failure involving the thoracic cavity identified as splenosis on nuclear medicine imaging and suspicion was raised given the remote history splenectomy after splenic rupture during trauma. We will discuss the imaging appearances of splenosis on CT, MRI and nuclear medicine studies, with emphasis on using nuclear medicine as a modality of choice to avoid biopsy. We will also go on to include a brief review of literature on this topic in this article. The key facts are role of detailed clinical history and requirement of high index of suspicion to avoid unnecessary intervention in the case of splenosis.

Abdominopelvic ectopic spleen with a comprehensive imaging examination: a case report.

Ectopic spleen is a rare clinical malformation in which the spleen is relocated from its normal anatomical position to other parts of the abdomen. We report a rare case of abdominopelvic ectopic spleen caused by splenic ligament deficiency. A patient experienced intermittent pain in the left upper abdomen that was progressively aggravated. This was confirmed by comprehensive imaging examinations and postoperative pathology. We also performed a review of the literature on the current state of the field. Our data may help to improve the diagnosis and treatment of ectopic spleen.

Torsion of Wandering Spleen Attached to the Omentum: A Rare Case Report from Iran.

BACKGROUND: Wandering spleen is a rare condition with less than 0.2% prevalence, and it is the cause of 0.25% of total splenectomies. This condition happens as a result of the lack or looseness of the spleen suspensory ligaments, and it may manifest as an acute abdomen due to the spleen becoming twisted around its vascular base. CASE PRESENTATION: This study reports the case of a wandering spleen attached to the omentum (with blood supply from the omentum) in the pelvic area, with ectopic appendix (located in the right upper quadrant), ectopic liver (located in the abdominal midline), and ectopic stomach (located in the right upper abdominal region), in a 15-year-old male complaining about abdominal pain, nausea, vomiting, and lack of appetite, who was referred to the hospital. The patient underwent laparotomy with the diagnosis of acute abdomen; the twisted ectopic spleen in the pelvis was removed and appendectomy was also performed. The clinical manifestations of wandering spleen vary extensively, and its presurgical diagnosis is difficult in the absence of radiological studies. Therefore, spleen torsion has to be considered as a diagnosis for acute abdomen in order to prevent necrosis of the spleen and other related complications. CONCLUSION: Wandering spleen should be borne in mind for patients presenting with a palpable intra-abdominal mass causing acute or intermittent abdominal symptoms.

Small bowel obstruction due to splenosis 30 years after splenectomy.

Splenosis is the autotransplantation of splenic tissue into abnormal locations due to trauma or iatrogenically. Usually, this causes no symptoms, but in rare cases the mass effect of the transplanted nodules can cause small bowel obstruction. Resection of the culprit splenic tissue is recommended, but not more extensive dissection of non-involved nodules. Our patient presented at 43 years of age with abdominal pain, distention and bilious vomiting. He had undergone a splenectomy at the age of 13 years due to splenic rupture after a motor vehicle collision. Computed tomography demonstrated a small bowel obstruction with multiple nodules suspicious of splenosis. The obstructing mass and compromised bowels. were resected. Final pathology confirmed the diagnosis. Splenosis is an uncommon aetiology of small bowel obstruction and must be considered in patients who had previous splenic trauma or surgery.

Torsion of wandering spleen involving the pancreatic tail.

BACKGROUND: Wandering spleen (WS) is a rare clinical entity resulting from the absence or maldevelopment of the ligaments normally involved in the attachment of the spleen in its normal position. WS can be a cause of acute abdomen leading to different complications ranging from torsion of the vascular pedicle to spleen infarction. Often, in absence of symptoms, it is an occasional finding during radiological exams and surgery represents the gold standard in the management of this unusual condition. CASE PRESENTATION: We present a case of wandering spleen in a young nulliparous female with an history of recurrent abdominal pain. A preoperative CT-scan of the abdomen showed the presence of a multi-infarcted spleen twisted several times around its vascular pedicle, involving the tail of pancreas. The patient was electively treated with laparoscopic splenectomy. CONCLUSIONS: A laparoscopic approach is feasible in the treatment of this pathology. A correct and timely diagnosis of this condition is crucial to allow an organ preserving surgery. There are only few reported cases in literature describing an involvement of the tail of the pancreas in the torsion of the vascular pedicle. Complete excision of the ectasic veins tributaries of the splenic vein avoids the risk of postoperative vein thrombosis and bleeding.

Splenorenal fusion mimicking renal cancer: One case report and literature review.

Splenorenal fusion is an extremely rare benign entity. This abnormality is presented in a case of a 29-year-old-male patient. We discuss the distinction between this condition and renal splenosis and their embryology. The course of this condition and modalities of investigation including radiological imaging, management, and pitfalls are reviewed.