Splenosis after laparoscopic splenectomy.

Abstract

We read with interest Kumar and Borzi’s article in the April 2001 issue of Surgical Endoscopy on splenosis in a port site after laparoscopic splenectomy [3]. They report the rare case of an 8-year-old boy with congenital spherocytosis who underwent laparoscopic splenectomy and cholecystectomy. Subsequently, port-site splenosis, a previously unreported complication of laparoscopic splenectomy, was diagnosed in the patient. The authors note that port-site splenosis should be considered in the differential diagnosis of port-site pain and a palpable nodule postsplenectomy. It might be profitably added that their point is equally applicable for all the known types of splenosis, which, although uncommon, are endoscopically manageable. Splenosis is an autotransplantation of splenic tissue, usually after splenic rupture [5]. Its incidence in patients who have undergone splenectomy for trauma is as high as 76%. Most implants are found in the left upper quadrant of the abdomen [7]. They may be found retroperitoneally [8], and even within the liver [1]. Thoracic splenosis may occur in cases of thoracoabdominal trauma with diaphragm rupture. It usually presents as a mass on the left side of the chest, but it also may involve the pericardium [7]. Thoracic and abdominal splenosis may coexist [10]. The rarest form of splenosis is its subcutaneous manifestation. This form of splenosis may occur in the celiotomy scar as an isolated nodule [11], or it may coexist with another focus of splenic autotransplantation including thoracic [9], abdominal [7], or extremitial [10]. In addition to the diagnostic dilemma splenosis poses, serious sequelae have been described including hemoptysis, spontaneous rupture with massive bleeding into body cavities, gastrointestinal bleeding [7], and problems mimicking myocardial infarction [2]. A preoperative diagnosis of splenosis requires a high index of suspicion [6]. Radionuclide scanning is a reliable noninvasive diagnostic method. The significant antipneumococcal antibody increase proved in patients with splenic autotransplantation, their adequate humoral response to pneumococcal infections [4], and the additional protective immunologic effect of splenosis [7] indicate that this rare condition actually may provide protection against overwhelming postsplenectomy infection or sepsis. In patients similar to the patient described by Kumar and Borzi, for whom splenectomy is beneficial and splenic autotransplantation must be avoided, preoperative use of imaging methods might improve diagnostic certainty and contribute to a well-planned surgical intervention.