Accessory spleen in the pancreatic tail -- a neglected entity? A contribution to embryology, topography and pathology of ectopic splenic tissue

Abstract

According to autoptic studies, accessory spleens may be found in 10% to 15% of the population, in 1% to 2% they are located in the pancreatic tail. They thus have to be taken into account in the differential diagnosis of intra- and peripancreatic tumorous lesions. After splenorenal fusion, they can be found pararenally and retroperitoneally, and after splenogonadal fusion they can descend into the pelvis or scrotum. Since they usually are asymptomatic, they are mostly discovered accidentally. The diagnosis is ascertained by a scintigram with technetium-99-marked, heat-damaged red blood cells. If resection is necessary, the organ adherent to the encapsulated accessory spleen should be preserved. By means of three case reports (intrapancreatic accessory spleen, retroperitoneal accessory spleen and torsion-infarcted wandering spleen), the surgical relevance of ectopic splenic tissue is discussed.