Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy

Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients

“…Most authors, despite the use of different imaging techniques, starting from ultrasonography through to classic and spiral computed tomography and scintigraphy with marked, denatured erythrocytes, underline the lack of reliable ways of preoperative assessment of ectopic splenic tissue [10,12,18,20,24,25]. Gigot et al, comparing CT scan results with scintigraphy, obtained the preoperative diagnosis of accessory spleens, verified positively during laparoscopic splenectomy, only in 25% of patients [20].…”

“…Most often, the presence of accessory spleens does not cause any clinical symptoms, though there are case reports describing accessory spleen-related acute abdominal syndromes such as torsion of the vascular colicle of the accessory spleen or mechanical ileus caused by its presence [19]. Their incidence is most likely much higher than it could be judged from clinical outcome after surgical treatment of ITP because accessory spleens are documented in more than 30% of all autopsies [23,24]. The second most frequent cause of the presence of tissue microscopically identified as splenic are autotransplants-so-called splenosis, which may be a result of abdominal trauma followed by discrete haemorrhage and spread of damaged splenic tissue into the lumen of the abdominal cavity.…”

“…This problem can be caused by insufficient resolution of the image offered by contemporary CT scans or by the missing of the small accessory organ most frequently located adjacent to the main spleen. Thus, unsatisfactory results from the preoperative search for accessory spleens led Morris, Szold and Targarona to conclude that the key point is "finding and removing accessory splenic tissue during the surgery, before the first attempt to excise the spleen itself" [11,21,24]. Although some authors suggest that the most commonly used method of operation, known as the "hanging spleen" technique, makes the approach to the sites with higher frequencies of accessory spleens more difficult [25], the opinion that the approach to the most essential topographical sites is sufficient is in favour.…”

“…It may be noted that this procedure is more feasible and safe than a classic, open approach for the patients with ITP, as the latter technique is often associated with greater blood loss and several perioperative complications [19,24]. In infrequent, but well-documented studies, the comparison of classic and laparoscopic approaches revealed the advantages and benefits of the minimally invasive one [22,25].…”

A case of splenosis after laparoscopic splenectomy

“…There have been few reported cases of splenosis after laparoscopic splenectony to date [2], but numbers are expected to increase in the future. The seeding of spilled splenic cells under high-pressure pneumoperitoneum during a slightly longer procedure is a new and specific problem in laparoscopic splenectomy [9].…”