Case 3: Abdominal Pain and Chronic Constipation in a 14-year-old Girl

Splenosis mimicking metastatic abdominal and pelvic tumours in a 12-year-old female patient

“…The data on the prevalence of splenosis following elective splenectomy is limited. In children, splenosis is extremely rare -isolated cases have been described [1,2,[9][10][11][12][13][14][15] with a single report of splenosis after splenectomy without rupture of the splenic capsule during the surgery [14,15]. Below we present a case of splenosis mimicking metastatic abdominal and pelvic tumours in a 12-year-old girl, who underwent splenectomy for congenital spherocytosis.…”

“…There have been reports of thoracic splenosis, both with and without diaphragm rupture [1,15]. The spread by blood vessels explains the cases of splenosis in the liver parenchyma [18][19][20][21], pancreas [4], mammary gland, and even the brain [11,12]. In the described case, the location of the lesions is typical and includes the greater omentum, intestinal wall and its mesentery, parietal peritoneum, and pelvis.…”

“…injury and posttraumatic splenectomy or an elective splenectomy due to haematological diseases. Only a few cases of splenosis in children aged 4-18 years have been described in the literature [1,2,[9][10][11][12][13][14][15]. Most of them report splenectomy after previous spleen injuries, while only single ones report this condition after elective splenectomy in patients with haematological disorders, such as HS [9,15], Wiskott-Aldrich Syndrome [14], and primary immune thrombocytopaenia [13].…”

“…In the analysed literature on splenosis in children, the time from spleen injury or splenectomy due to the haematological diseases to the diagnosis of splenosis is from about 1 year [10,13] to 6 years [2,14]. However, in patients who have undergone splenectomy in childhood due to trauma, the time to diagnosis varies from 5 months [4,10,16] to as much as 55 years [3], 10 years on average [4,12,16]. The asymptomatic course and the fact that most of these people are unlikely to undergo any other medical imaging or surgery makes it even more difficult to estimate the prevalence of splenosis [2,11,14,16] and may explain why it is diagnosed less frequently in children than in adults [12].…”

“…In most cases, splenosis is asymptomatic and can be detected during surgery or medical imaging unrelated to its occurrence [1][2][3][4]. Splenic implants localized in the abdominal cavity can cause intestinal obstruction and related signs and symptoms such as abdominal pain, nausea, vomiting, constipation, and fever [2,[9][10][11][12]16]. Appendicitis or hydronephrosis due to pressure on the appendix or ureters also can occur [17].…”