Splenosis after laparoscopic splenectomy

Extensive intrathoracic and intraperitoneal splenosis mimicking mesothelioma: a case report

Background

Splenosis is the heterotopic autotransplantation of splenic tissue after severe splenic trauma and/or splenectomy. The epidemiology is elusive, but splenosis is frequently misdiagnosed as malignant tumors of gastrointestinal, gynecological, or hematological origin before the correct diagnosis is ultimately found. We herein report a rare case of combined, extensive intraabdominal and intrathoracic splenosis initially presenting as pleural mesothelioma.

Case presentation

A 63-year-old Caucasian male presented with dyspnea and recurring thoracic pain. Initial X-ray and computed tomography scans showed disseminated intrathoracic and intraabdominal lesions. Consequently, thoracoabdominal mesothelioma or a polytopically metastasized cancer of unknown origin was suspected. A thorough examination of the patient’s medical history and contrast-enhanced ultrasound by a skilled examiner revealed the diagnosis of extensive abdominal and thoracic splenosis as a consequence of an abdominal gunshot wound with a ruptured diaphragm several decades earlier. Timely diagnosis by noninvasive measures prevented the patient from potential complications of harmful diagnostic procedures, including nuclear imaging and biopsies. The patient is currently treated for hepatitis C and chronic obstructive lung disease, whereas no specific treatment for splenosis is required.

Conclusions

We present a case of rare intrathoracic and intraperitoneal splenosis mimicking mesothelioma. Contrast-enhanced ultrasound and thorough patient history were used for diagnosis and prevented this patient from having to undergo potentially harmful diagnostics. Splenosis can occur after splenic trauma and, consequently, needs to be considered as a rare differential diagnosis to malignant tumors of various origins when a matching patient history is obtained.

Case report: A follow up of a major pelvic splenosis

The authors present a case of a young female with extensive pelvic splenosis, which was complicated by torsion of one of the splenosis nodules operated by laparoscopy. She has been followed during several years. The diagnosis was made on the basis of the history, imaging (ultrasound, CT scan, MRI, and Technetium 99m-labeled embrittled red blood cell scans), and blood workup. The diagnosis of splenosis can be made via complications such as torsion, infarction, hemorrhage, or most often incidentally. The treatment without symptoms is abstention.

Pelvic splenosis mimicking a suspicious adnexal mass

A 58-year-old asymptomatic woman was referred to our gynecologic oncology unit for the management of a left adnexal mass found during a routine gynecologic examination. Her personal history included an emergency splenectomy at the age of 4 years old, following traumatic splenic laceration after a car accident. The patient's work-up (including transvaginal ultrasound and MRI) confirmed a pelvic solid mass, which was reported as suspicious for malignancy and classified as Ovarian-Adnexal Reporting & Data System-MRI 5. An exploratory laparoscopy was performed, showing a reddish blue lesion located at the left broad ligament. Histologic analysis showed the presence of splenic tissue and normal adnexa. The postoperative follow-up was uneventful.Pelvic splenosis is a challenging diagnosis rarely made preoperatively due to concern for malignancy. In the presence of a pelvic mass, the collection of a detailed patient's history, including information about previous splenic rupture, might raise suspicion for pelvic splenosis.

Cecal splenosis mimicking gastrointestinal stroma tumor. Case report and review of the literature

Introduction

Abdominal splenosis is a rare condition where autotransplanted ectopic spleen tissue is found in the abdominal cavity after spleen injury or splenectomy. While abdominal splenosis is mostly described as asymptomatic, bowel splenosis can present with abdominal pain, obstipation or gastrointestinal (GI) bleeding. Scarce information on bowel splenosis exists and high index of suspicion is needed for diagnosis. We present the case of a patient with abdominal pain and a cecal mass mimicking gastrointestinal stroma tumor (GIST) found to have bowel splenosis after laparoscopic resection.

Presentation of case

A 45-year-old female was evaluated for a 6-month history of abdominal pain in right-lower quadrant. She had past medical history of blunt abdominal trauma and splenectomy 35 years before symptoms. An abdominal contrast-enhanced computed tomography (CT) reported a 4.2 × 4.6 × 4.6 cm solid mass located in the antimesenteric border of the cecum, with calcifications and arterial enhancement. Colonoscopy found no epithelial lesions. A diagnostic laparoscopy was done, and resection of the mass achieved. Transoperative histopathological diagnosis revealed ectopic spleen tissue.

Discussion

It is difficult to know whether abdominal pain in bowel splenosis is actually triggered by splenosis itself or by an unrelated cause, making diagnosis incidental. There are no particular imaging findings suggestive of splenosis, and surgical resection is often done under uncertain diagnosis.

Conclusion

Bowel splenosis could present as abdominal pain variable time after spleen injury or splenectomy. Clinical features and imaging characteristics are nonspecific and similar to those of GIST. Most cases of splenosis are diagnosed after surgery.

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Bowel splenosis is a rare entity scarcely reported in the literature.

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2nd case with more years from risk factor reported.

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We expose a review of the literature analyzing common findings.

Endoscopic Ultrasound-Guided Needle-Based Probe Confocal Laser Endomicroscopy (nCLE) of Intrapancreatic Ectopic Spleen

Accessory spleens and splenosis represent the congenital and acquired type of ectopic splenic tissue. Generally, they are asymptomatic entities posing as solid hypervascular masses at the splenic hilum or in other organs, such as the pancreas. Intrapancreatic ectopic spleen mimics pancreatic neoplasms on imaging studies, and due to the lack of radiological diagnostic criteria, patients undergo unnecessary distal pancreatectomy. We present the first case of intrapancreatic ectopic spleen in which the concomitant use of needle-based probe confocal laser endomicroscopy and fine-needle aspiration supported the final diagnosis.

Splenosis: A Rare Etiology for Bowel Obstruction-A Case Report and Review of the Literature

Splenosis is a historically uncommon etiology for bowel obstruction. Autotransplanted splenic tissues following surgery or trauma of the spleen are known to occur in multiple locations of the abdominal cavity and pelvis. The small bowel mesentery is a blood vessel-rich environment for growth of splenic fragments. We present a case of a 36-year-old male patient who sustained a gunshot wound to his left abdomen requiring a splenectomy and bowel resection fifteen years prior to his presentation with small bowel obstruction requiring exploration, adhesiolysis, and resection of the mesenteric splenic deposit. Our aim in this report is to provide awareness of splenosis as an etiology for bowel obstruction, especially with increased incidence and survival following abdominal traumas requiring splenectomies. We also stress on the importance of history and physical examination to include splenosis on the list of differential diagnoses for bowel obstruction.

Post-traumatic intrahepatic splenosis mimicking a neuroendocrine tumour

A 52-year-old man presented with abdominal pain with a background of splenectomy 25 years previously. Initial investigations lead to suspicion of a neuroendocrine tumour. Positron emission tomography octreotide scanning and chromogranin were raised. He subsequently underwent a lateral segmentectomy. The histopathology was consistent with splenosis. 1. Splenosis must be considered as differential in any patient with abdominal symptoms post-traumatic splenectomy. 2. Positron emission tomography (PET) octreotide scanning can detect splenosis giving false positives for a neuroendocrine tumour. This is the first case to describe such an association.

A case of splenosis after laparoscopic splenectomy

Splenosis is the heterotopic autotransplantation of splenic tissue usually following traumatic rupture of the spleen or surgical manipulation of splenic tissue. Although it is generally asymptomatic, it may present with abdominal pain or mass. Furthermore, there may be recurrence of the hematological disorders for which the patient underwent splenectomy. We report a rare case of splenosis in a 9-year-old girl after laparoscopic splenectomy for hereditary spherocytosis, which required laparotomy due to bowel obstruction.

Laparoscopic Splenectomy in Children: Experience in a Single Institution

PURPOSE

To assess the safety and effectiveness of laparoscopic splenectomy in children.

MATERIALS AND METHODS

Hospital records of 63 patients who underwent laparoscopic splenectomy between 1998 and 2005 were reviewed retrospectively. In 16 patients concomitant cholecystectomy was performed. All procedures were performed by the same surgeon. The indications for splenectomy were hereditary spherocytosis (n = 35), idiopathic thrombocytopenic purpura (n = 22), autoimmune hemolytic anemia (n = 3), and other diseases (n = 3). Details of operative technique were reviewed and their implications on intraoperative complications are analyzed. The postoperative course and long-term results were assessed.

RESULTS

There were 35 girls and 28 boys, whose average age was 11.3 years (range, 3.9-19.5 years). There were 7 conversions, mainly at the beginning of the series. A mild degree of intraoperative bleeding was observed in 23 (36.5%) cases. In two cases (3%) severe bleeding led to conversion. Postoperatively, 1 patient required blood transfusion and 1 patient had signs of mild general infection that was treated conservatively. There was no mortality in this series. The mean operation time was 134 minutes for splenectomy and 174 minutes for splenectomy and cholecystectomy. Operative time did not significantly diminish at the end of the 7-year study period.

CONCLUSION

Laparoscopic splenectomy in children performed by an experienced team proved to be safe and effective with minimal side effects and should be recommended as a procedure of choice in children who require splenectomy.