Colonic obstruction caused by accessory spleen torsion: A rare case report and literature review

Rupture of an accessory spleen caused by blunt trauma

PURPOSE

The accessory spleen is quite a common abdominal anomaly. However, the traumatic accessory spleen rupture is an extremely rare condition requiring surgical intervention, even laparotomy. 9 cases of traumatic accessory spleen were found published between 1962 and 2022. The study aims to evaluate traumatic accessory spleen rupture cases regarding their causes, clinical course, and possible diagnosis without surgery and treatment.

METHODS

Desk research method using available online databases. Descriptive methods were employed to analyze the collected data. The results are summarized in the Table concerning gender, age, injury details, accessory spleen injury characteristics, treatment, and others such as previous splenectomy or primary spleen involvement in injury or accompanying abdominal injuries.

RESULTS

In total, there were 9 cases of traumatic accessory spleen, of which 2 were managed conservatively and the remaining 7 were treated operatively. All the patients survived. One-third of all included patients already had their primary spleen removed, which facilitated the diagnosis of traumatic rupture of an accessory spleen. The proper diagnosis of an accessory spleen rupture was concluded in 2 cases and confirmed in surgery.

CONCLUSION

The recognition of the traumatic rupture of an accessory spleen before surgery is challenging but can be made easier if the patient underwent splenectomy before. The traumatic accessory spleen rupture does not coexist with an injury of a primary spleen.

Torsion of the Accessory Spleen in a Child With Acute Abdomen

Accessory splenic torsion is a rare condition that occurs when the accessory spleen twist on its pedicle, leading to a loss of blood supply and subsequent tissue damage. It is a rare cause of acute abdomen with few cases reported in the literature. We report a case of accessory spleen torsion in a 16-year-old male with abdominal pain. The patient, whose lesion was interpreted as a hematoma on imaging at an external center, was admitted to our center with increased, intermittent abdominal pain. The patient's complaints and physical examination were similar to peptic ulcer perforation. Abdominal ultrasonography and abdominal CT performed for differential diagnosis showed a 45x50 mm heterogeneous, hypodense, well-defined lesion located in the splenic hilus, posterior to the stomach, and adjacent to the pancreatic tail. In our center, the lesion was considered to be lesser sac omental torsion and was operated on. A 720-degree torsed accessory spleen was found at surgery and resected. Accessory splenic torsion is not primarily a condition that comes to mind in children with abdominal pain. However, in case of delay in diagnosis and treatment, many complications can be seen. The fact that ultrasonography or computed tomography cannot clearly define accessory splenic torsion also complicates this diagnosis. In such cases, performing diagnostic laparotomy/laparoscopy reveals the definitive diagnosis and is very important in preventing complications.

Radiologic Findings of Single Accessory Splenic Infarction in a Patient with Accessory Spleens in the Abdominal Cavity: A Case Report

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.

Surgical resection for accessory spleen torsion: A case report

INTRODUCTION

Accessory spleen torsion is extremely rare, and surgery is often the emergency or elective treatment of choice.

PRESENTATION OF CASE

A 20-year-old female with no specific medical history presented to our outpatient clinic with a chief complaint of abdominal pain. The patient was diagnosed with accessory spleen torsion by computed tomography. However, the abdominal symptoms and inflammatory reaction based on blood tests were mild, so a conservative treatment was selected. Subsequently, blood tests were normalized, and imaging studies showed that the accessory spleen was shrinking. Contrast-enhanced examination showed contrast enhancement in a portion of the infarcted accessory spleen region, indicating that the accessory spleen torsion had been released. Surgical resection was performed to prevent possible future re-torsion and hemorrhage of the accessory spleen.

DISCUSSION

The removed specimen seemed to be normal accessory spleen tissue with clear infarcted foci edges. This artery showed evidence of luminal organization and untwisting of the occluded artery.

CONCLUSION

This accessory spleen torsion was treated conservatively; however, the patient was referred for surgical treatment.

Torsion of an Accessory Spleen in a Child With Biliary Atresia Splenic Malformation Syndrome

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.

Infarcted accessory spleen masquerading as a mesenteric cyst

An accessory spleen is a rare entity which is usually asymptomatic. When symptomatic, it presents as an acute abdomen, with either torsion, rupture or haemorrhage. We present the case of a 20-year-old man who presented with chronic lower abdominal pain since 3 months and a lump in the left lower quadrant. On clinical examination and investigations, the lump was diagnosed as a mesenteric cyst, and an uncomplicated laparoscopic excision was performed. The postoperative histopathological examination reported it as an infarcted accessory spleen.