Ectopic Spleen Research Articles

Accessory Splenic Mass Masquerading as Hepatocellular Carcinoma: A Diagnostic Dilemma

The spleen plays a pivotal role in our immune system by facilitating the proliferation and differentiation of lymphocytes and monocytes. Typically located in the left upper quadrant retroperitoneally, splenic tissue found outside of its usual position is termed ectopic spleen. When the tissue maintains its histological architecture and encapsulation and receives blood supply from splanchnic vessels, it is called an accessory spleen. Although it commonly presents near the splenic hilum or pancreatic tail, rare instances have been reported in the gastric, liver, gastrosplenic/lienorenal ligaments, as well as thoracic and gonadal regions. However, the case of an accessory spleen, mimicking a hepatic lesion in the right diaphragm represents a novel observation.

Splenic torsion mistaken for an ovarian cyst: a case report

BackgroundWandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed.Case presentationA 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days.ConclusionSplenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.

Ectopic spleen in testicular parenchyma: case report

Clinical case description: This report presents the case of a 32-year-old man with palpable solid nodule in the left testicle with a diagnostic hypothesis of testicular cancer, which turned out to be splenic tissue through pathological anatomy analysis. Relevance: The splenogonadal fusion is a rare and benign congenital anomaly related to the presence of ectopic spleen tissue in the gonadal parenchyma, caused by fusion between these two tissues during the fifth or sixth week of embryonic development. This condition is of great importance because its diagnosis is difficult and often confused with other gonadal disorders such as testicular neoplasm. Clinical implications: The most common consequence of this testicular disorder is the unnecessary orchiectomy, in which a variety of cases are submitted. To avoid testicle removal, intraoperative pathological examination can be used in these cases. Conclusions: The ectopic spleen in testicular parenchyma is a rare condition and its diagnosis is difficult. It is important to consider this condition as a differential diagnosis in testicular disorders, especially in the case of diagnostic hypothesis of testicular cancer, so that testicle removal can be prevented by the use of intraoperative pathological exam.

Ectopic Spleen with Segmental Portal Hypertension, About a Case

Ectopic spleen is a condition in which the spleen does not sit in the left hypochondrium but has an atypical, often pelvic, location. We report the case of a 35-year-old patient suffering from chronic abdominal pain for 11 years associated with an episode of hematemesis, pollakiuria and dysuria, with anemia and notion of multiple transfusions. Abdominal ultrasound found an ectopic spleen in the pelvic position, enlarged in size, with multiple collateral venous circulations and extensive partial thrombosis of the splenic vein. A total splenectomy by midline laparotomy was performed. Perioperative exploration found a bulky pelvic spleen with a long and tortuous splenic pedicle, involuted in 3 turns without splenic infarction. When the splenic artery is clamped, the colonic and gastric varicose veins lose half their diameter, so the decision is made to perform total splenectomy. Post-splenectomy antibiotic prophylaxis and vaccination was administered. The follow-up was favorable, with a follow-up of 4 years. The patient was then lost sight of.

Ectopic Spleen in the Pelvis: A Case Report

Ectopic spleen is a rare clinical condition characterized by splenic hypermobility caused by elongation or mal-development of the suspensory ligaments leading to the presence of spleen outside of its normal position. It is most commonly presented in children younger than 1 year and in females of childbearing age.A 34-year-old woman underwent magnetic resonance imaging (MRI) after suspicion of uterine fibroids. The patient only complained of a painless lower abdominal mass. MRI revealed the enlarged spleen in the pelvic area, measuring 17 × 4.6 cm, suspended by elongated, dilated, and tortuous pedicle in the absence of the spleen in its normal position. Multiple factors could be attributed to the development of an ectopic spleen. These include the following: (1) congenital anomalies in the development of the dorsal mesogastrium and the absence or malformation of the normal splenic suspensory ligaments, (2) acquired conditions such as splenomegaly and pregnancy. An ectopic spleen can present in a variety of ways clinically. It might pass unnoticed throughout life. However, ectopic spleen should be considered in the differential diagnosis of patients presented with an abdominal mass. Imaging modalities are used to make a final diagnosis. The treatment choice for an ectopic spleen is splenopexy. Splenectomy is only necessary in case of an infarction.

Uncommon Cause of Acute Abdomen: Ectopic Pelvic Spleen

The ectopic spleen is rare, characterized by splenic hyper-mobility resulting from laxity or poor development of the splenic suspensory ligaments.this allows to wandering spleen to draw, by the force of gravity, to the lower abdomen attached only to its abnormally elargated vascular pedicule. It is usually detected in the childhood. The clinical presentation is vaious; it may attributed to complications: torsion, rupture, arterial infraction and compresion. Diagnosis in emergency situations can be difficult because splenic volvulus is a rare cause of an acute abdomen. We present and discuss a case of an ectopic spleen in the pelvic position leading to paroxysmal abdominal pain, diagnosed by ultrasound, confirmed by computed tomography and treated by splenectomy.

A140 ECTOPIC SPLEEN PRESENTING AS A GASTRIC SUBMUCOSAL LESION

Abstract Background Accessory spleen is ectopic splenic tissue which can be either congenital or acquired. It is usually an asymptomatic incidental finding. In the context of known malignancy, accessory spleen can be mistaken for metastasis. Purpose Here, we share a case of ectopic spleen presenting as a gastric subepithelial lesion post splenectomy. Rare cases have been reported in the literature. Method Case Report and Literature Review Result(s) Case: A middle age male with history of splenic rupture secondary to a motor vehicle accident and metastatic renal cancer was found to have a gastric subepithelial lesion on endoscopy. Endoscopic ultrasound (EUS) revealed a subepithelial mass coming off the submucosa or muscularis mucosa of the gastric wall with intact muscularis propria. EUS-guided core biopsy was performed and demonstrated splenic tissue Conclusion(s) Splenic tissue should be considered in the differential diagnosis when assessing gastric subepithelial tumors even in the context of previous trauma to the spleen. In addition, EUS-guided core biopsy may be required to rule out metastatic disease. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared ESOPHAGEAL, GASTRIC & DUODENAL DISORDERS

Torsion of wandering spleen as acute abdominal pain emergency: case report

Anatomic variations of the normal position of the spleen in the left upper quadrant is an uncommon condition called wandering spleen or ectopic spleen. This condition has an incidence rate <0.2% and is most often diagnosed in children under one year of age or in women who are in their third decade of life, the most referred symptoms presented by patients are abdominal pain, either acute or intermittent, associated with a palpable mass in lower abdomen. There are two main causes, congenital or acquire, treatment is surgery being two main approaches splenectomy and splenopexy depending on clinical features, diagnosis is bases on images, gold standard computed tomography and ultrasound.

Wandering Spleen: A Rare Condition with Splenic Torsion and Infarction in an Elderly Patient

Ectopic spleen or wandering spleen is an uncommon presentation in which the spleen's anatomical location is different from its fixed position in the left upper quadrant of the abdomen, due to the absence of the typical peritoneal attachments; the spleen is more mobile inside the abdomen. Congenital or acquired conditions are the cause of this anomaly, which could ultimately result in torsion and splenic infarction. Less than 0.2% of wandering spleen cases are reported annually, making it a rare clinical manifestation. Splenic vascular pedicle torsion can result in complications that can cause symptoms of an acute abdomen as a result of ischemic necrosis of the spleen. Computed tomography and ultrasonography with Doppler or CEUS are essential for accurate diagnosis due to the vague clinical signs and potential complications. This case involves a 70-year-old elderly woman who complained of extreme abdominal pain and vomiting for three days. On physical examination, a tense right lower quadrant lump was palpated, when she visited the emergency room. An urgent CT scan was done for the acute abdomen which revealed torsion of the splenic pedicle in a wandering spleen.

Intrapancreatic ectopic spleen: difficulties in differential diagnosis

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Epidermal Cyst in an Intrapancreatic Accessory Spleen.

A 59-year-old asymptomatic woman with no disease history presented to our institution for investigation of a pancreatic tail mass. Hematological parameters were within normal ranges, including serum carcinoembryonic antigen levels and carboxyhydrate antigen 19-9. Computed tomography revealed a strongly enhanced solid peripheral mass with an intracystic component in the pancreatic tail (Figure A, arrow). Magnetic resonance imaging revealed a cystic lesion on the T2 image surrounded by a solid component with density and intensity levels similar to those in the spleen parenchyma (Figure B, arrow). Endoscopic ultrasonography showed a solid hyperechoic 20-mm mass and an intracystic hypoechoic component showing stronger enhancement by Sonazoid (MSD Inc) than the pancreatic parenchyma (Figure C, arrow). Laparoscopic distal pancreatectomy was used for diagnosis. Pathological examination revealed a white and red sinus of the ectopic spleen in the pancreatic tail, with a unilocular cyst lined with stratified squamous epithelium, indicating an epidermal cyst in the intrapancreatic accessory spleen (Figure D, arrows). Most epidermal cysts in the intrapancreatic accessory spleen cases are found incidentally, typically as single monolobular cystic lesions in the pancreatic tail with a thickened cystic wall or solid components identical in density to the spleen on imaging examinations, making a definite preoperative diagnosis extremely difficult, resulting in unnecessary surgical intervention.

Pelvic splenosis in a patient with a 20-year history of splenectomy

Pelvic splenosis, also called ectopic pelvic spleen, is a rarely reported clinical condition. Pelvic splenosis refers to autotransplantation of splenic tissue resulting from seeding into the pelvic space that typically occurs after trauma. This report presents the case of a 39-year-old male with a rectal lesion. After a laparoscopic low anterior resection of rectosigmoid colon with colorectal anastomosis, the lesion was resected and diagnosed as an ectopic pelvic spleen. Pelvic splenosis requires no treatment in most cases. Surgery is considered only if it is accompanied with acute complications. When the diagnosis remains unclear, further biopsy or laparoscopy is recommended. If pelvic splenosis is confirmed, careful follow-up is beneficial. Finally, pelvic splenosis should be considered in the differential diagnosis of pelvic masses in patients with a history of splenectomy.

Wandering spleen

A 25-year-old female presented to our hospital with severe abdominal pain of two days’ duration. A routine obstetric ultrasound several years prior had revealed an enlarged spleen, but she was otherwise healthy and had carried two uneventful pregnancies to term. Physical exam on arrival in the emergency room was notable for a tender mass in the subumbilical region. A CT scan revealed an enlarged and ectopic spleen (A, B) with twisting of its vascular pedicle and numerous venous collaterals adjacent to the splenic vein (A, C – arrows). The patient was admitted to the general surgery department but declined any surgical intervention following symptomatic improvement and was discharged. A so-called wandering spleen is a rare condition thought to be due to laxity of the splenic ligaments. Our patient’s acute presentation was likely due to a self-resolving episode of splenic vessel torsion, with previous episodes likely resulting in congestive splenomegaly

Twisting an Ectopic Spleen: About A Case in the General Surgery Department of Sikasso Hospital (Mali)

Pedicle torsion is the most common complication of ectopic spleen. The observation we bring was the case of a 20 year old lady admitted to the emergency room with an acute surgical abdomen picture evolving for about two years. Clinical examination revealed generalized abdominal pain and a mass in the right iliac fossa. The torsion of the spleen was suspected by the clinic, the abdomino-pelvic ultrasound and confirmed during an exploratory laparotomy. Intraoperatively the spleen was necrotic on a long twisted pedicle indicating a splenectomy.

Wandering Spleen - A Possible Cause of Adrenal “Mass” - Case Report

Abstract Wandering spleen is a very rare clinical condition characterized by spleen absence in the normal anatomical location in the upper left quadrant of the abdomen and its presence at another location in the abdomen or pelvis. The ectopic spleen is extremely rare in children, where its increased mobility is the result of a congenital disturbance of the fixation for the anterior wall due to the absence or weakness of the supporting ligaments. Wandering spleen is usually asymptomatic, but its torsion is possible, as well as infarction or rupture which demand an urgent diagnosis and surgical treatment. The diagnosis of wandering spleen can easily be overlooked due to low incidence and insufficient clinical experience, which multiplies patient's risk from life-threatening conditions. We present a case of wandering spleen in an 11-year-old girl with acute abdominal pain, which after ultrasound examination raised suspicion on the right adrenal gland tumor. Additional diagnostics verified an ectopic spleen in the right adrenal box, after which the recommended preventive splenopexy was seriously considered. Due to the fixation of the vital spleen in the new position, but also the negative attitude of the parents towards the surgical intervention, clinical monitoring was selected, with exclusion of intense physical activity that carries the risk of traumatization of the spleen. As the girl has been in good health for over 3 years and without symptoms, we consider that the selection of conservative access although difficult, was correct. We hope that our experience in treating wandering spleen in girls will increase the number of valid facts about this rare condition.

Wandering spleen as a cause of sinistral portal hypertension

Wandering spleen (WS) is a rare entity characterized by laxity of peritoneal ligaments that hold the spleen stationary. It is most commonly diagnosed in children and young women. Clinical presentation ranges from asymptomatic to acute abdomen. A 19-yearold woman came to the emergency department with history of progressive abdominal pain. She also had previous episodes of hematemesis. A computed tomography scan showed an ectopic spleen with a “whirlpool sign.” Laparotomy and splenectomy were performed. WS is characterized by a long vascular pedicle and laxity of peritoneal attachments of the spleen. The etiology is usually congenital. Splenopexy is the main treatment; however, splenectomy is indicated when splenic infarction is present. Despite being rare, this condition may be considered in some cases of abdominal pain. An earlier diagnosis would have allowed us to perform a splenopexy, thus reducing morbidity.

A female patient with painful abdominal lump- torsion of wandering spleen

We present a 65 year old female patient presented with acute onset of severe left sided abdominal pain associated with a tender intra-abdominal lump over the left flank. An abdominal ultrasonography revealed an ectopic spleen in left flank and a CE-CT scan of abdomen confirmed the wandering spleen with torsion of vascular pedicle at the hilum. She underwent splenectomy. Wandering spleen is an uncommon clinical entity. Review of literature was made on different clinical presentations, diagnostic evaluation, treatment options, and clinical outcomes of patients with wandering spleen and discussed in this case report.

Torsion of the wandering spleen as an abdominal emergency: a case report

BackgroundWandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium.Case presentationA 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of the wandering spleen’s pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully.ConclusionEven though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.

Cecal splenosis mimicking gastrointestinal stroma tumor. Case report and review of the literature.

IntroductionAbdominal splenosis is a rare condition where autotransplanted ectopic spleen tissue is found in the abdominal cavity after spleen injury or splenectomy. While abdominal splenosis is mostly described as asymptomatic, bowel splenosis can present with abdominal pain, obstipation or gastrointestinal (GI) bleeding. Scarce information on bowel splenosis exists and high index of suspicion is needed for diagnosis. We present the case of a patient with abdominal pain and a cecal mass mimicking gastrointestinal stroma tumor (GIST) found to have bowel splenosis after laparoscopic resection.Presentation of caseA 45-year-old female was evaluated for a 6-month history of abdominal pain in right-lower quadrant. She had past medical history of blunt abdominal trauma and splenectomy 35 years before symptoms. An abdominal contrast-enhanced computed tomography (CT) reported a 4.2 × 4.6 × 4.6 cm solid mass located in the antimesenteric border of the cecum, with calcifications and arterial enhancement. Colonoscopy found no epithelial lesions. A diagnostic laparoscopy was done, and resection of the mass achieved. Transoperative histopathological diagnosis revealed ectopic spleen tissue.DiscussionIt is difficult to know whether abdominal pain in bowel splenosis is actually triggered by splenosis itself or by an unrelated cause, making diagnosis incidental. There are no particular imaging findings suggestive of splenosis, and surgical resection is often done under uncertain diagnosis.ConclusionBowel splenosis could present as abdominal pain variable time after spleen injury or splenectomy. Clinical features and imaging characteristics are nonspecific and similar to those of GIST. Most cases of splenosis are diagnosed after surgery.

Torsion of the Vascular Pedicle of A Wandering Spleen: An Unusual Cause of Intestinal Strangulation

Ectopic spleen is a rare splenic malformation. Apart from torsion of the vascular pedicle, a common complication, an ectopic spleen could be responsible of an acute intestinal obstruction. We report a case of an 8-year-old girl who presented an acute abdomen, following of the transverse colon strangulation by the torsion of the vascular pedicle of a wandering spleen. The patients benefited a surgical opening into the abdomen who has been confirmed the diagnosis and made a detorsion of the vascular pedicle of spleen with splenopexy.The interest of this case report lies on the rarity of a wandering spleen and on the unusual situation of transverse colon strangulation by the vascular pedicle of spleen.