Dynamic computed tomography findings of an accessory spleen in the pelvis: a case report

Abstract

We report the case of a 60-year-old man with an accessory spleen in the pelvis. He visited our outpatient clinic because of abdominal discomfort. Computed tomography (CT) showed an enhanced mass (40 mm in diameter) in the pelvis. Preoperative diagnosis was difficult even after magnetic resonance imaging and colonoscopy. The patient underwent surgery for suspicion of a gastrointestinal stromal tumor or malignant lymphoma of the rectum. Intraoperative findings showed a mass in the pelvis and a long cord-like tissue reaching the mass and arising from the great omentum; the mass was excised. Histopathologic examination indicated that the mass was splenic tissue, and feeding vessels were found in the cord-like tissue, which were determined to be derived from the left gastroepiploic artery and vein. Thus, we diagnosed it as an accessory spleen in the pelvis. An accessory spleen is not rare and can occur anywhere in the abdominal cavity. However, an accessory spleen in the pelvis is an infrequent finding, and only 9 other cases of an accessory spleen in the pelvis have been reported. Therefore, it is very difficult to make a correct diagnosis preoperatively. However, 7 of the 9 cases (77.8 %) of a pelvic accessory spleen had vascular pedicles from the great omentum or splenic hilum as feeding vessels; hence, determining the feeding blood vessels on dynamic CT may be useful for diagnosing an accessory spleen in the pelvis. Additionally, if the accessory spleen is symptomatic or has a vascular pedicle, surgeons should attempt to resect the accessory spleen in the pelvis using minimally invasive laparoscopy.

Multiple pelvic accessory spleen: Rare case report with review of literature

“…According to the literature in English language of the past 30 years (from 1987 to 2017) retrieved online from PubMed (https://www.ncbi.nlm.nih. gov/pubmed/), only 16 cases of pelvic AS have been reported, to the best of our knowledge (2,(4)(5)(6)(7)(8)(9)(10)(12)(13)(14)(15)(16)(17)(18)(19).…”

“…AS is generally detected during radiological investigations or during open or laparoscopic surgeries (5)(6)(7)13). Abdominal computed tomography (CT), magnetic resonance imaging and scintigraphy with Tc-99 m are helpful in making the diagnosis of pelvic AS (14,17). Ota et al (14) concluded that 77.8% (7/9) of feeding vessels of a pelvic AS originated from the great omentum or splendid hilum, and thus, delineating the feeding blood vessels on dynamic CT may be useful for diagnosing AS in the pelvis.…”

“…Abdominal computed tomography (CT), magnetic resonance imaging and scintigraphy with Tc-99 m are helpful in making the diagnosis of pelvic AS (14,17). Ota et al (14) concluded that 77.8% (7/9) of feeding vessels of a pelvic AS originated from the great omentum or splendid hilum, and thus, delineating the feeding blood vessels on dynamic CT may be useful for diagnosing AS in the pelvis. For most pelvic AS, regular monitoring by ultrasound inspection is recommended instead of invasive over-treatment.…”

Giant accessory spleen and rotating ectopic kidney: A rare association

“…The spleen is an encapsulated organ composed of lymphatic and vascular tissue, located in the left hypochondrium [8]. Some variations in its development have already been observed, including complete agenesis, polysplenia, isolated accessory spleens, and persistent lobulations [9,18].…”

“…An AS is commonly located near the spleen's hilum and in the pancreas tail, and is generally asymptomatic and diagnosed incidentally during laparotomy or radiological examination performed for other reasons [7]. Adnexal masses typically originate from the genital tract; however, extrapelvic organs are rarely found in this location [8]. Although extremely rare, this possibility must be considered in the differential diagnosis of pelvic masses.…”