Spontaneous hemorrhage from splenic tissue 13 years after total splenectomy: report of a case

Takehiro Maki,Hitoshi Inomata,Kenjiro Misu,Makoto Omi,Kazuyoshi Nihei,Masatoshi Tateno,Daisuke Ishii,Hiroyuki Kaneko

doi:10.1186/s40792-015-0099-0

Abstract

A 33-year-old man suffered sudden abdominal distension without traumatic episodes. He had undergone total splenectomy for hereditary spherocytosis 13 years ago. He was in shock, and his hemoglobin level was 10.5 g/dl. Contrast enhanced computed tomography revealed a giant mass in the left upper abdomen and extravasation of the contrast material into the mass. Excision of the mass was performed, and microscopic examination showed a giant hematoma surrounded by normal splenic tissue. We speculated that an accessory spleen or splenosis had enlarged for the 13 years and ruptured. The patient remained asymptomatic 4 months after the surgery. Spontaneous hemorrhage from accessory spleens or splenosis is extremely rare, and relevant case reports suggest that surgical resection of bleeding sites yields favorable prognosis although preoperative qualitative diagnosis seems to be difficult.

Highlights

We often encounter accessory spleens in radiological studies, abdominal surgeries, or autopsies
Compared to the primary spleen and accessory spleens, splenic implants have a thinner capsule which is devoid of elastic tissue and the white pulp area or hilum is usually deficient [8]
We experience a case of spontaneous hemorrhage from splenic tissue 13 years after total splenectomy

Summary

Background

We often encounter accessory spleens in radiological studies, abdominal surgeries, or autopsies. We here present a very rare case which suffered life-threatening bleeding from splenic tissue without traumatic episodes total splenectomy had been done 13 years ago, followed by a review of the literature. Case presentation A 33-year-old Japanese man suffered sudden abdominal distension and visited our hospital by ambulance. He did not have any symptoms before the onset and denied histories of trauma. Connected to the intramesenteric hematoma, a giant mass was observed at the left upper quadrant of the abdomen. It looked like just a hematoma or some kind of neoplasm and was firmly adhered to the pancreatic tail; it was excised with the pancreatic tail.

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Discussion

Conclusions