Wandering accessory spleen

Accessory wandering spleen: Report of a case of laparoscopic approach in an asymptomatic patient

INTRODUCTION

Accessory wandering spleen is a rare but dangerous condition. Abnormalities of the ligamentous apparatus of an accessory spleen may evolve into torsion of its vascular axis, which can lead to a splenic infarct making surgery necessary. Patients are often asymptomatic and the diagnosis can be accidental. An early diagnosis and a correct treatment are fundamental.

PRESENTATION OF CASE

In this case report a young woman underwent laparoscopic surgery after an incidental finding at a Pelvic Ultrasound of an accessory wandering spleen.

DISCUSSION

In literature are reported cases of asymptomatic patients with an accessory wandering spleen treated with a conservative approach. However, a torsion or infarct of the accessory wandering spleen leads to emergency surgery. The presence of an independent vascular axis of the accessory spleen reduces the risk of postoperative complications (e.g. thrombocytosis) and the administration of low molecular weight heparin should prevent the risk of portal thrombosis.

CONCLUSION

We suggest performing surgery with a laparoscopic approach in patients with accessory wandering spleen, though asymptomatic, because of the risk of serious complications in case of accessory spleen torsion.

Symptomatic wandering accessory spleen in the pelvis: sonographic findings

We describe the case of a mobile left lower quadrant mass associated with recurrent abdominal pain; at surgical exploration, the mass was found to be an accessory pelvic spleen. Although accessory spleens are present in 10-30% of individuals, a wandering accessory spleen located in the pelvis is not frequently seen. On sonography, the mass in our patient appeared well-defined and homogeneous. Spectral analysis and color Doppler imaging demonstrated a normal vascular branching pattern and high diastolic flow due to low resistance in the vascular bed. The parenchymal resistance index of the mass was similar to that of the native spleen.

Wandering spleen in childhood: a report of three cases

Wandering spleen is a rare cause of abdominal pain in children, and an accurate diagnosis is seldom made preoperatively. A splenectomy is the treatment of choice in cases of splenic torsion and infarction, while in patients with chronic symptoms splenopexy may also be attempted. We herein report three patients with wandering spleen, of whom two presented with acute torsion of the splenic pedicle and one demonstrated an asymptomatic mobile abdominal mass. In the first case splenopexy was attempted, but during follow-up the spleen was found to have undergone atrophy. The presentation, diagnostic procedures, and treatment modalities in pediatric wandering spleen are reviewed.