Spontaneous necrosis and hemorrhage in an enlarged accessory spleen: CT demonstration

Accessory Spleen Fracture: Report of a Pediatric Case and Review of the Literature

Accessory spleen rupture may occur after blunt abdominal trauma or, more rarely, spontaneously. Although only few cases are described in adults, it is even more uncommon in children. We report the case of a 13-year-old boy with traumatic accessory spleen fracture. After a review of the literature, we discuss the diagnostic points that should raise the suspicion for accessory spleen fracture as well as how challenging the diagnosis by computed tomography can be.

Spontaneous hemorrhage from splenic tissue 13 years after total splenectomy: report of a case

A 33-year-old man suffered sudden abdominal distension without traumatic episodes. He had undergone total splenectomy for hereditary spherocytosis 13 years ago. He was in shock, and his hemoglobin level was 10.5 g/dl. Contrast enhanced computed tomography revealed a giant mass in the left upper abdomen and extravasation of the contrast material into the mass. Excision of the mass was performed, and microscopic examination showed a giant hematoma surrounded by normal splenic tissue. We speculated that an accessory spleen or splenosis had enlarged for the 13 years and ruptured. The patient remained asymptomatic 4 months after the surgery. Spontaneous hemorrhage from accessory spleens or splenosis is extremely rare, and relevant case reports suggest that surgical resection of bleeding sites yields favorable prognosis although preoperative qualitative diagnosis seems to be difficult.

Torsion of an accessory spleen: Case report and review of the literature

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.