English

Abstract

Accessory spleen (AS) is a congenital ectopic splenic tissue arising during embryologic period of development, most remaining asymptomatic and discovered incidentally. Being present near the splenic hilum usually, it may occasionally be embedded partly or wholly in the tail of the pancreas, sometimes becoming symptomatic and even mimicking tumor. We report a case of an accessory spleen discovered during cadaveric dissection of a middle-aged man in the Department of Anatomy, RIMS, Imphal. Awareness of the possible presence of AS is important during splenectomy for conditions such as immune thrombocytopenic purpura as failure to remove the AS may result in the failure of the condition to resolve. Additionally, during medical imaging, AS may be confused for enlarged lymph nodes or neoplastic growths. The presented case report might remind us the sort of such congenital anomalies during clinical evaluations like splenomegaly, splenic trauma, lymphadenopathies and intra-abdominal mass and subsequent operative strategies. KEY MESSAGE: A routine search for AS intraoperatively along with preoperative radiological scan is recommended to achieve the highest detection rates and to prevent disease recurrence, especially for autoimmune hematological disorders. INTRODUCTION: The spleen consists of a large encapsulated mass of vascular and lymphoid tissue situated in the upper left quadrant of the abdominal cavity between the fundus of the stomach and the diaphragm. The spleen can display various developmental anomalies, including complete agenesis, multiple spleens or polysplenia, isolated small additional splenunculi and persistent lobulation1. Accessory spleens may be formed during embryonic development as ectopic or separated splenic tissue along the path from where the spleen forms at the midline to the spleen's final location on the left side of the abdomen.1, 2 Accessory spleen, found in 10%-30% of patients at autopsy, is due to the fusion failure of the splenic anlage, which is located in the dorsal mesogastrium. 3- 5 The splenic hilus is the most common site of an accessory spleen followed by pancreatic tail. Because an accessory spleen does not usually require treatment, accurate preoperative diagnosis is important.