Colonic obstruction caused by accessory spleen torsion

Abstract

Rationale:Accessory spleen torsion is a rare cause of the acute abdomen. The complications of accessory spleen torsion, such as intestinal obstruction, are rarer. We herein report a case of colonic obstruction caused by accessory spleen torsion because of the unusual condition.Patient concerns:A 15-year-old patient presented with acute intestinal obstruction with signs of peritoneal irritation. Abdominal computed tomography (CT) and ultrasonography examinations revealed a soft tissue mass in the left midabdomen. Systemic inflammatory response syndrome (SIRS) was observed in this case.Diagnoses:The diagnosis of peritonitis and colonic obstruction secondary to accessory spleen torsion was made. Pathologic examination showed infracted splenic tissue.Interventions:We performed emergency laparotomy and found that accessory spleen torsion pressured against splenic flexure and descending colon, and caused colon obstruction. The patient underwent accessory splenectomy and enteral decompression.Outcomes:At 6 months follow-up, the patient recovered well with perfect digestion.Lessons:Accessory spleen torsion and its complications are extremely rare. This entity should be considered in differential diagnosis of acute abdomen. However, in case of acute abdomen with critical clinical situation, emergency surgical intervention is necessary for timely diagnosis and treatment.

Torsion of an Accessory Spleen in a Child With Biliary Atresia Splenic Malformation Syndrome

“…Complications, such as torsion and infarction, are extremely rare. To the authors knowledge, only 19 pediatric cases of accessory splenic torsion, including the current case, have been described in the English literature (2)(3)(4)(5)(6)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). This is the second reported case of an accessory splenic torsion occurring in a child with known situs inversus and the only documented case in a patient with BASM (5).…”

“…Almost all reported pediatric cases of accessory splenic torsion are diagnosed at time of surgery (4,5,9,11,13,14,(16)(17)(18). Once confirmed, management is typically operative, however conservative management has proven successful (6).…”

“…Diagnosis is typically made in the operating room as diagnostic imaging is often times unrevealing. Definitive treatment is almost always splenectomy (4,5). Herein, the authors describe an unusual presentation of a torted splenule in a 5-year-old patient with biliary atresia splenic malformation syndrome (BASM).…”

Accessory spleen torsion: a rare cause of acute abdominal pain

“…Accessory spleens are congenital anomalies defined as nodules of ectopic splenic tissue which are hung by a vascular pedicle and are discrete from the spleen. 1,2 During embryogenesis the spleen forms from fusion of multiple mesenchymal cells migrating to the dorsal mesogastrium, and failure of this fusion can lead to one or more nodules remaining seperate. 1 The great majority of splenunculi have a silent clinical course and may remain undetected for the duration of a patient's life.…”

Accessory spleen mimicking an intra‐abdominal tumour

“…An accessory spleen (AS) is a congenital anomaly found in approximately 10–30% of the population, caused by the failure of separate splenic masses forming on the dorsal mesogastrium to fuse . AS needs to be differentiated from splenosis, an autotransplantation of splenic tissue due to splenic trauma or iatrogenesis .…”