Isolated sarcoidosis of accessory spleen in the greater omentum: A case report

[Hepatosplenic sarcoidosis: description of a case at the University hospital center of Brazzaville, Congo]

Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The isolated extrapulmonary form is rare. We report the case of hepatosplenic sarcoidosis in a 29-year-old female patient.It is a patient with no notable medical history, who was seen in consultation for repeated epistaxis. Clinical examination noted nodular hepatomegaly associated with signs of portal hypertension and splenomegaly. Sedimentation rate, alkaline phosphatase, serum angiotensin converting enzyme, aminotransferases were high. Histological examination of the spleen and liver biopsy noted granulomatous inflammatory infiltration without cancerous lesion or tonsil stones.This picture is comparable with sarcoidosis, despite the absence of PET scans. The main challenge remains the differential diagnosis with other granulomatoses. Corticosteroid therapy is the first-line treatment, and after splenectomy the patient has achieved clinical and biological stability.

Chronic splenic torsion in a dog with an accessory spleen

A 4-year-old, neutered male, mixed breed Old English sheepdog was presented for evaluation and treatment of anorexia, vomiting, and diarrhea. Presumptive severe pancreatitis was diagnosed based on the referral bloodwork. Abdominal ultrasonography identified a suspected liver lobe torsion based on the presence of a normal spleen. However, an exploratory laparotomy identified a splenic torsion in addition to a grossly normal spleen. Key clinical message: This case demonstrates that a second, potentially large area of splenic tissue (ectopic or accessory) can be present in the dog; therefore, the presence of a normal appearing spleen on abdominal ultrasonography does not rule out splenic torsion.

Isolated splenic sarcoidosis: a rare cause of hypercalcaemia in a patient with type 1 diabetes

A 30-year-old man was admitted to Intensive Therapy Unit (ITU) with status epilepticus secondary to severe hypoglycaemia on a background of type 1 diabetes. CT of the brain showed generalised cerebral oedema. He was successfully stepped down to a medical ward after 2 weeks. He was noted to have persistently high calcium, which required multiple doses of pamidronate. Parathyroid hormone level was appropriately low. CT of the thorax, abdomen and pelvis showed mild hepatosplenomegaly with small pathological lymph nodes throughout the abdomen. Bone marrow biopsy was unremarkable. Lymph node biopsy was difficult to achieve, and therefore a positron emission tomography scan was arranged. This showed an enlarged and hypermetabolic spleen. Differential diagnoses at this point included lymphoma and sarcoidosis. He underwent diagnostic splenectomy, and the diagnosis of sarcoidosis was confirmed histologically. Calcium level remained normal 17 months after splenectomy.

A life-threatening small bowel obstruction as onset of an unknown sarcoidosis: A case report

Sarcoidosis is a systemic granulomatous disorder of unknown etiology characterized by non-caseating granulomas at the site of disease. A confident diagnosis should be established by the evidence of typical granulomas on biopsy and after exclusion of other conditions. Clinically recognizable Gastrointestinal involvement (GI) occurs in less than 1.6% of patients with sarcoidosis, with data revealing small intestine participation in 0.03% of the cases and few anecdotal reports describe a peritoneal presentation. Clinical manifestations of peritoneal sarcoidosis are abdominal discomfort, bloating, weight loss, epigastric and peri-umbilical pain with or without ascites, bowel obstruction. Treatment depends on symptoms and disease activity.

Herein we describe the case of a 42-years-old male patient who developed an acute, life–threatening small bowel obstruction as first manifestation of sarcoidosis.

To the best of our knowledge, this is the only report showing such extensive and acute onset of intra-abdominal sarcoidosis in the absence of a previous disease manifestation and without pulmonary involvement.

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Abdominal sarcoidosis is a sporadic event and localization without pulmonary involvement is rarer mimicking GI diseases.

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Reaching abdominal sarcoidosis diagnosis is not a straightforward process.

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It is pivotal to confirm sarcoidosis diagnosis before subjecting patients to an appropriate treatment.

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Corticosteroids are considered the cornerstone treatment.

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Asymptomatic patients may undergo a watch and wait follow-up with no need for a pharmacological therapy.

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Surgery is not often required but individualized patient evaluation is recommended.

Extensive Abdominal Sarcoidosis Without Pulmonary Manifestation

Background: Sarcoidosis is a rare multisystem disease of idiopathic etiology that affects different organs and is characterized histopathologically by the presence of noncaseating granulomas. The most common location of sarcoidosis is the lungs, accounting for approximately 95% of sarcoidosis cases. Coincident involvement of pulmonary and extrapulmonary organs is present in approximately one-third of patients. However, the sole involvement of intraabdominal organs is extremely rare. Intraabdominal sarcoidosis has a different presentation depending on the involved organs. To the best of our knowledge, a limited number of case reports have been published on intraabdominal sarcoidosis without pulmonary involvement. Case Report: A 69-year-old female patient presented with short onset of abdominal pain and change in bowel habits, without a significant medical history of abdominal problems. Physical examination only revealed generalized abdominal tenderness on deep palpation. Computed tomography of the abdomen and pelvis showed mild to moderate thickening of the omentum and other abdominal organs. After excluding various etiologies such as fungi and acid-fast bacilli, the omentum, ovaries, and surrounding lymph nodes were removed via a laparoscopic procedure. The histopathology report confirmed the diagnosis of intraabdominal sarcoidosis with the presence of noncaseating granulomas. Conclusion: Extrapulmonary sarcoidosis is a rare disease, and intraabdominal sarcoidosis might mimic other malignant etiologies. We treated our case with laparoscopic removal of involved organs and oral steroids with significant recovery during a short period.

Multiple pelvic accessory spleen: Rare case report with review of literature

Accessory spleen (AS) usually presents as an isolated asymptomatic mass of splenic tissue separated from the body of the actual spleen. Multiple pelvic ASs are more unusual than single pelvic AS. The present study reported on the rare case of multiple pelvic AS. A 39-year-old Chinese woman presented at our hospital with complaints of abdominal pain for one week. A large pelvic mass behind the uterus was identified on ultrasound examination. Multiple AS in the pelvis was primarily considered during the operation and confirmed by histopathological examination after the surgery. The literature in English language was also reviewed by retrieving studies on AS published over the past 30 years, and it was discussed how to diagnose and treat pelvic AS. In conclusion, to the best of our knowledge, the present study provided the first case report of multiple pelvic AS. The gynecologist should be aware of the rare possibility of an AS in patients with abdominal and pelvic complaints and/or a pelvic mass. Pelvic AS is generally determined during radiological investigations or during open or laparoscopic surgeries.