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Xu N, Xu Y, Zhu Q. Radiologic Findings of Single Accessory Splenic Infarction in a Patient with Accessory Spleens in the Abdominal Cavity: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040807. [PMID: 37109765 PMCID: PMC10144062 DOI: 10.3390/medicina59040807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
The presence of multiple accessory spleens in the abdominal cavity is typically limited to two, with cases involving a higher number being exceedingly rare. Concurrently, accessory spleen infarction is remarkably uncommon, primarily resulting from torsion of the vascular pedicle. In this report, we present a case of a 19-year-old male who experienced infarction in one of four accessory spleens. Imaging diagnosis proved challenging, with the definitive diagnosis being made through postoperative pathology, revealing no torsion in the affected accessory spleen. Following surgery combined with anti-inflammatory and analgesic treatment, the patient exhibited an uneventful recovery. No complications were observed at the 3-month follow-up. This case indicates the challenge and difficulty of diagnosing accessory splenic infarction without torsion in imaging diagnosis. Employing a multimodality approach and diffusion-weighted imaging may aid in confirming the diagnosis.
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Affiliation(s)
- Nan Xu
- Department of Ultrasonography, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yingchen Xu
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Qiang Zhu
- Department of Ultrasonography, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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2
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Yoshida M, Saida T, Masuoka S, Urushibara A, Chiba F, Masumoto K. Preoperative Diagnosis of a Torsioned Accessory Spleen. J Med Ultrasound 2021; 29:116-118. [PMID: 34377643 PMCID: PMC8330679 DOI: 10.4103/jmu.jmu_35_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
We report a case of a 12-year-old boy with an accessory spleen torsion. He presented with left-sided abdominal pain after trauma. A 4 cm oval mass without contrast enhancement was detected on contrast-enhanced computed tomography (CT), and ultrasound (US) showed a 4 cm oval mass below the spleen. The mass mainly consisted of high echoes similar to the spleen; the central part showed irregularly low echoes. Subsequent follow-up daily US examinations showed gradual expansion of the central low echoes with conspicuous hyperechoic dots. Discontinuation of the branch from the splenic artery to the mass was observed, both, on US and CT. These findings led to the diagnosis of a hemorrhagic infarct caused by torsion of the accessory spleen. Laparoscopy showed adherence of the accessory spleen to the omentum and colon by twisting four times around its axis. It was resected and confirmed the diagnosis of a torsioned accessory spleen.
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Affiliation(s)
- Miki Yoshida
- Department of Radiology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tsukasa Saida
- Department of Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Souta Masuoka
- Department of Radiology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Aiko Urushibara
- Department of Radiology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Fumiko Chiba
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kouji Masumoto
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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3
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A review of anatomy, pathology, and disease spread in the perisplenic region. Abdom Radiol (NY) 2021; 46:805-817. [PMID: 32949273 DOI: 10.1007/s00261-020-02736-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
The perisplenic region is a complex anatomical area involving multiple peritoneal and subperitoneal structures, which influence the presentation and behavior of various pathologic processes. This review is a comprehensive resource for perisplenic anatomy and pathology with associated clinical presentations and imaging findings. Understanding the pathophysiologic intricacies of the perisplenic region assists the radiologist in building a helpful differential diagnosis and recognizing predictable disease patterns.
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4
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Ganarin A, Fascetti Leon F, La Pergola E, Gamba P. Surgical Approach of Wandering Spleen in Infants and Children: A Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:468-477. [PMID: 33428514 DOI: 10.1089/lap.2020.0759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Splenopexy has been proposed as the treatment of choice in case of wandering spleen (WS). We report our experience and review the current literature focusing on surgical management and outcomes of children affected by WS. Materials and Methods: Data regarding demographics, clinical manifestations, diagnosis, and treatment of children treated for WS at our Institution were analyzed. Systematic review was registered on Prospero (CRD42018089971). Scientific databases were searched using defined keywords. Articles were selected using predefined exclusion and inclusion criteria. Analysis was conducted adding our center's cases. Results: One hundred sixty-six articles were included in the review, 197 cases were analyzed, 3 of which unpublished. Female/male ratio was 1.5:1 and median age at diagnosis was 8 years. Most frequent clinical manifestation was isolated abdominal pain (42.6%). Torsion of splenic pedicle was diagnosed in 56.3%. Among surgical procedures, 39% underwent splenopexy and 54.8% underwent splenectomy. In case of splenopexy, the most commonly used techniques were using of a mesh (45.5%) or creation of a retroperitoneal pouch (30.9%). In 48.2% of splenopexies, minimally invasive surgery (MIS) was used. Splenopexy was effective in 94.8% (88% considering only cases with a spleen torsion). Conclusion: WS is a rare condition potentially leading to torsion of the spleen. This entity has to be kept in mind as a differential diagnosis in case of abdominal pain. Splenopexy should be the treatment of choice; its success rate in terms of preserved spleens can be affected by the presence of a torted organ. Retroperitoneal pouch or mesh fixation are the most preferred techniques. Authors recommend MIS approach.
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Affiliation(s)
- Alba Ganarin
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Enrico La Pergola
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
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Simon DA, Fleishman NR, Choi P, Fraser JD, Fischer RT. Torsion of an Accessory Spleen in a Child With Biliary Atresia Splenic Malformation Syndrome. Front Pediatr 2020; 8:220. [PMID: 32432066 PMCID: PMC7212802 DOI: 10.3389/fped.2020.00220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
Torsion of an accessory spleen is an exceedingly rare cause of abdominal pain in pediatric patients. The diagnosis is frequently challenging as presentation is variable and diagnostic imaging can be aspecific. The current case describes an unusual presentation of a torted accessory spleen in a 5-year-old girl with biliary atresia splenic malformation syndrome who initially presented with non-specific abdominal symptoms and fever. The diagnosis was made following fine-needle aspiration of a suspected intraabdominal abscess. The case highlights the diagnostic challenge of accessory splenic torsion and stresses the importance of its inclusion on the differential diagnosis of pediatric patients, especially those with known splenic or laterality abnormalities, presenting with both acute and sub-acute abdominal symptoms.
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Affiliation(s)
- David A Simon
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States
| | - Nathan R Fleishman
- Department of Gastroenterology and Hepatology, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States
| | - Pamala Choi
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States
| | - Jason D Fraser
- Department of Pediatric Surgery, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States
| | - Ryan T Fischer
- Department of Gastroenterology and Hepatology, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States
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Ren C, Liu Y, Cao R, Zhao T, Chen D, Yao L, Pan Z. Colonic obstruction caused by accessory spleen torsion: A rare case report and literature review. Medicine (Baltimore) 2017; 96:e8116. [PMID: 28953636 PMCID: PMC5626279 DOI: 10.1097/md.0000000000008116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Accessory spleen torsion is a rare cause of the acute abdomen. The complications of accessory spleen torsion, such as intestinal obstruction, are rarer. We herein report a case of colonic obstruction caused by accessory spleen torsion because of the unusual condition. PATIENT CONCERNS A 15-year-old patient presented with acute intestinal obstruction with signs of peritoneal irritation. Abdominal computed tomography (CT) and ultrasonography examinations revealed a soft tissue mass in the left midabdomen. Systemic inflammatory response syndrome (SIRS) was observed in this case. DIAGNOSES The diagnosis of peritonitis and colonic obstruction secondary to accessory spleen torsion was made. Pathologic examination showed infracted splenic tissue. INTERVENTIONS We performed emergency laparotomy and found that accessory spleen torsion pressured against splenic flexure and descending colon, and caused colon obstruction. The patient underwent accessory splenectomy and enteral decompression. OUTCOMES At 6 months follow-up, the patient recovered well with perfect digestion. LESSONS Accessory spleen torsion and its complications are extremely rare. This entity should be considered in differential diagnosis of acute abdomen. However, in case of acute abdomen with critical clinical situation, emergency surgical intervention is necessary for timely diagnosis and treatment.
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Affiliation(s)
| | | | | | | | | | | | - Zhili Pan
- Department of Radiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui, China
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7
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Lü YF, Han BB, Yu HL, Cui ZH, Li ZW, Wang JX. Accessory spleen appearing as an intrasplenic pseudo-tumoral mass: A rare case report. Oncol Lett 2015; 10:982-984. [PMID: 26622609 DOI: 10.3892/ol.2015.3331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 04/14/2015] [Indexed: 11/06/2022] Open
Abstract
The current study presents a rare case of an accessory spleen that manifested as a solid intrasplenic pseudotumor. The affected patient was previously healthy. Upon examination with computed tomography (CT), an ovoid, soft-tissue mass of ~4.1 cm in diameter was found on the upper pole of the spleen. Biochemical indices, such as blood routine and coagulation tests, and tumor marker analysis, revealed no abnormalities. Another CT scan was performed, but this failed to indicate whether the mass was benign or malignant. Therefore, the lesion was resected along with the spleen by laparoscopic surgery. The resected sample was subject to pathological examinations for final validation, and was finally diagnosed as an accessory spleen. The patient was followed up for six months with no signs of recurrence.
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Affiliation(s)
- Yan-Feng Lü
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Bing-Bing Han
- Microcirculation Laboratory, Shangdong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China
| | - Hua-Long Yu
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Zhen-Hua Cui
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Zhi-Wen Li
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
| | - Jian-Xin Wang
- Department of Anoproctology, The Second Hospital of Shandong University, Jinan, Shandong 250033, P.R. China
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8
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Ozeki M, Asakuma M, Go N, Ogura T, Inoue Y, Shimizu T, Hirokawa F, Yamamoto K, Hayashi M, Narumi Y, Higuchi K, Uchiyama K. Torsion of an accessory spleen: a rare case preoperatively diagnosed and cured by single-port surgery. Surg Case Rep 2015; 1:100. [PMID: 26943424 PMCID: PMC4596154 DOI: 10.1186/s40792-015-0101-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/01/2015] [Indexed: 12/04/2022] Open
Abstract
We report a very rare case of acute abdomen caused by torsion of an accessory spleen that was preoperatively diagnosed and cured by single-port surgery. A 31-year-old woman was admitted to our hospital with severe left abdominal pain. Physical examination revealed a left upper quadrant abdominal tenderness with voluntary guarding. Ultrasound demonstrated a well-defined round mass isoechoic to the spleen, measuring 3.0 cm in diameter in the left upper quadrant adjacent to the spleen. A contrast-enhanced CT scan showed a normally enhanced spleen and a 3.0 × 3.0, hypodense, non-enhancing mass anterior to the spleen with a twisted funicular structure. Torsion of an accessory spleen was suspected, and emergency single-port surgery was performed. During surgery, a rounded violet mass measuring 3.0 cm in diameter, suggestive of an accessory spleen, with a 1800° torsion around a long vascular pedicle along the left side of the greater omentum was discovered. The mass was removed and post-operative recovery was uneventful. A review of the literature revealed 26 cases (including ours) of torsion of an accessory spleen in English. Even with the recent advances in radiologic imaging modalities, making a preoperative diagnosis of this is difficult and most cases are diagnosed during laparotomy. This is the first report preoperatively diagnosed and cured by single-port surgery. We decided to start the operation by using a single port, not only for cosmetic reasons for this young female patient, but also for final confirmation of our diagnosis. We believe that single-port laparoscopy is valuable as a diagnostic tool as long as safety is assured for patients with acute abdomen. Although torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in children and young adults.
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Affiliation(s)
- Maiko Ozeki
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan.
| | - Mitsuhiro Asakuma
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan.
| | - Nakai Go
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan.
| | - Takeshi Ogura
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan.
| | - Yoshihiro Inoue
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan.
| | - Tetsunosuke Shimizu
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan.
| | - Fumitoshi Hirokawa
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan.
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan.
| | - Michihiro Hayashi
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan.
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan.
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan.
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan.
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9
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10
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Wang G, Chen P, Zong L. Accessory spleen arising from the gastric fundus mimicking gastrointestinal stromal tumor following splenectomy: A case report. Exp Ther Med 2013; 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] [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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11
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Splenic anomalies of shape, size, and location: pictorial essay. ScientificWorldJournal 2013; 2013:321810. [PMID: 23710135 PMCID: PMC3654276 DOI: 10.1155/2013/321810] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/01/2013] [Indexed: 12/19/2022] Open
Abstract
Spleen can have a wide range of anomalies including its shape, location, number, and size. Although most of these anomalies are congenital, there are also acquired types. Congenital anomalies affecting the shape of spleen are lobulations, notches, and clefts; the fusion and location anomalies of spleen are accessory spleen, splenopancreatic fusion, and wandering spleen; polysplenia can be associated with a syndrome. Splenosis and small spleen are acquired anomalies which are caused by trauma and sickle cell disease, respectively. These anomalies can be detected easily by using different imaging modalities including ultrasonography, computed tomography, magnetic resonance imaging, and also Tc-99m scintigraphy. In this pictorial essay, we review the imaging findings of these anomalies which can cause diagnostic pitfalls and be interpreted as pathologic processes.
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12
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Abstract
Torsion of an accessory spleen is an uncommon cause of abdominal pain. Only a few cases have been reported in the literature. Most cases occur in children, and in most cases the diagnosis is made at surgery. We report a case of torsion of an accessory spleen in an adult female who presented with acute left-flank pain. The diagnosis was made on contrast-enhanced computed tomography (CT) and was confirmed at surgery. Without treatment, torsion of an accessory spleen can lead to hemorrhagic shock, peritonitis, and bowel obstruction. It is useful for the radiologist to make this diagnosis on imaging so that biopsy can be avoided and surgery performed to avoid complications.
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13
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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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14
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d'Amico A, Cofalik A, Przeorek C, Gawlik T, Olczyk T, Kalemba M, Modorowska A, Turska-d'Amico M, Bobek-Billewicz B, Jarzab B. Role of nuclear medicine imaging in differential diagnosis of accessory spleens in patients after splenectomy. Pol J Radiol 2012; 77:68-71. [PMID: 22802870 PMCID: PMC3389951 DOI: 10.12659/pjr.882585] [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: 10/27/2011] [Accepted: 01/11/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND More than 10% of healthy population has one or more accessory spleens. The most common location is the hilum of the spleen or area near the tail of the pancreas. The radiological appearance of accessory spleens in oncologic patients who underwent splenectomy can be misinterpreted as a recurrence, especially in the case of compensatory growth of an accessory spleen in successive radiological examinations. CASER REPORTS: We present the cases of three patients who underwent splenectomy for gastric carcinoid, gastric adenocarcinoma and cancer of the left adrenal gland, respectively. CT examination and/or PET-CT scan revealed suspicious findings in the left upper abdomen. In one patient, the dimensional increase of this finding in successive examinations was initially considered suggestive for cancer recurrence. Scintigraphy with (99m)Tc-nanocolloid was able to confirm the presence of an accessory spleen in all these patients. CONCLUSIONS Splenic scintigraphy is an economical, accessible and accurate tool in differential diagnosis of accessory spleens in patients after splenectomy.
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Affiliation(s)
- Andrea d'Amico
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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15
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Ishibashi H, Oshio T, Sogami T, Nii A, Mori H, Shimada M. Torsion of an accessory spleen with situs inversus in a child. THE JOURNAL OF MEDICAL INVESTIGATION 2012; 59:220-3. [PMID: 22450011 DOI: 10.2152/jmi.59.220] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We present an unusual case of acute abdomen caused by torsion of an accessory spleen with situs inversus in a child. A three-year-old girl was admitted to our hospital with an 11-day history of right flank pain with fever. Her medical history revealed an operation of coarctation of the aorta with situs inversus at one month of age. Physical examination revealed a right flank mass and tenderness. A contrast-enhanced CT scan showed a normally enhanced small spleen in the right upper quadrant and a 7.0×6.0×3.5 cm, hypodense, marginal enhancing mass in the right midabdomen adjacent to the intestine. An emergency laparotomy was decided upon with a preoperative diagnosis as an acute abdomen. During surgery, a mass was found under the greater omentum and two accessory spleens of 1.5 cm in diameter were found surrounding the main spleen. Several loops of bowel were adherent to the mass. The loops of bowel were dissected away. A pediculated congested mass was observed as an accessory spleen emerging from the greater omentum. The mass was twisted on its vascular pedicle and strangulated. The necrotic mass was removed and the postoperative recovery was uneventful. Though torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in childhood.
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Affiliation(s)
- Hiroki Ishibashi
- Department of Pediatric Surgery, National Kagawa Children's Hospital, Kagawa, Japan
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16
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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: 2.5] [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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17
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Impellizzeri P, Montalto AS, Borruto FA, Antonuccio P, Scalfari G, Arena F, Romeo C. Accessory spleen torsion: rare cause of acute abdomen in children and review of literature. J Pediatr Surg 2009; 44:e15-8. [PMID: 19735802 DOI: 10.1016/j.jpedsurg.2009.06.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 06/10/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
Abstract
Torsion of an accessory spleen is an extremely rare condition. We describe an unusual case of acute abdomen caused by torsion of an accessory spleen in a 12-year-old boy. The patient underwent a laparotomy with splenectomy; the course was favorable. We discuss the clinical findings and values of preoperative instrumental diagnosis. The literature is also reviewed. This is the 11th case reported in the English literature. Torsion of an accessory spleen should be considered in the differential diagnosis of acute abdomen or subacute abdominal pain.
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18
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Merran S, Karila-Cohen P, Servois V. [CT anatomy of the normal spleen: variants and pitfalls]. ACTA ACUST UNITED AC 2007; 88:549-58. [PMID: 17464253 DOI: 10.1016/s0221-0363(07)89854-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Normally, the spleen is located in the left hypochondrium. It is attached by the gastrosplenic and splenorenal ligaments. Its tissue composition made up of red pulp and white pulp explains the heterogenous aspect when contrast medium is injected in the arterial phase. This can make it difficult to detect intrasplenic masses. The adult spleen has no lobulations or incisures; however, the persistence of fissures separating the fetal spleen's lobules can indicate splenic lacerations in a trauma context. The ectopic spleen is a migration of the spleen from its normal anatomic location because its ligaments have not developed properly. The spleen can migrate anywhere in the abdomen or pelvis. The accessory spleen can be found in 10% of the population; it is usually located near the hilum of the main spleen or the pacreatic tail. It can be located in many other places and be confused with a mass. Polysplenia is a complex congenital syndrome associating visceral heterotaxis and concomitant bilateral left-sidedness. The spleen is divided into several splenules of the same size. Splenosis is defined by the implantation of splenic tissues in the peritoneum following traumatic rupture of the spleen.
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Affiliation(s)
- S Merran
- Service d'Imagerie Médicale, Fédération Mutualiste Parisienne, 24 rue Saint Victor, 75005 Paris, France.
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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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Grinbaum R, Zamir O, Fields S, Hiller N. Torsion of an accessory spleen. ACTA ACUST UNITED AC 2005; 31:110-2. [PMID: 16317489 DOI: 10.1007/s00261-005-0042-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Accepted: 03/16/2005] [Indexed: 10/25/2022]
Abstract
Torsion of an accessory spleen is extremely rare. We report a case of an acute torsion of an accessory spleen in a young patient who presented with acute left abdominal pain and discuss the computed tomographic findings of this exceptional condition. Awareness of this entity and familiarity with typical imaging findings are mandatory for preoperative diagnosis.
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Affiliation(s)
- R Grinbaum
- Department of Surgery, Hadassah Mount Scopus University Hospital, Jerusalem, 91240, Israel
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Jung NY, Rha SE, Byun JY, Kang WK. A patient with acute abdominal pain and a peritoneal mass on ultrasound and multidetector CT. Br J Radiol 2005; 78:771-2. [PMID: 16046437 DOI: 10.1259/bjr/92427993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- N Y Jung
- Department of Radiology, Kangnam St. Mary's Hospital, College of Medicine, Catholic University of Korea, 505 Banpo-dong, Seocho-Gu, Seoul 137-040, South Korea
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Abstract
OBJECTIVE The purpose of this study was to describe the prevalence and CT features of the accessory spleen. CONCLUSION Accessory spleens are present in 16% of patients undergoing contrast-enhanced abdominal CT. Typically, accessory spleens appear on CT scans as well-marginated, round masses that are smaller than 2 cm and enhance homogeneously on contrast-enhanced images. When accessory spleens are smaller than 1 cm, their attenuation may be lower than that of the spleen because of partial volume effects. Their most frequent location (22%) is posteromedial to the spleen; anterolateral to the upper pole of the left kidney; and lateral, posterior, and superior to the tail of the pancreas. Familiarity with these characteristic features may differentiate them from other pathologic findings in the upper abdomen.
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Affiliation(s)
- Koenraad J Mortelé
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
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Gayer G, Zissin R, Apter S, Atar E, Portnoy O, Itzchak Y. CT findings in congenital anomalies of the spleen. Br J Radiol 2001; 74:767-72. [PMID: 11511506 DOI: 10.1259/bjr.74.884.740767] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There is a wide range of congenital anomalies of the spleen. Some are common, such as splenic lobulation and accessory spleen. Other less common conditions, such as wandering spleen and polysplenia, have particular clinical significance. Radiologists need to be aware of the various congenital variants of the spleen in order to recognize clinically important anomalies and to avoid mistaking less significant ones for an abnormality. In this pictorial review, the embryology of congenital anomalies of the spleen as well as their appearance on CT are described, diagnostic pitfalls are identified and complications of the anomalies are discussed.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel
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