Torsion of an accessory spleen: Case report and review of the literature

Sadro, Claudia T.; Lehnert, Bruce E.

doi:10.2484/rcr.v8i1.802

Cited by 12 publications

(15 citation statements)

References 23 publications

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“…An accessory spleen is a benign developmental anomaly which occurs due to incomplete fusion of primordial mesenchymal buds of splenic tissue in the dorsal mesogastrium during the fifth week of embryonic life. 3 As the spleen originates in the dorsal mesogastrium and then rotates to the left side of the abdominal cavity, accessory spleens are almost always located within the left side the body. 1,2 They can be solitary or multiple and despite their relatively high frequency (from 10 to 30% of the population based on autopsy studies), most accessory spleens are asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…1,5 Accessory spleens receive their blood supply from feeding arteries off the splenic artery and can be found in various locations including the A B splenic hilum (75%), tail of the pancreas (20%), gastrosplenic ligaments, lienorenal ligaments, the greater omentum, the mesentery and even the pelvis or scrotum. [1][2][3] They are most commonly diagnosed incidentally during radiological examinations performed for other reasons and generally range in size from 2 to 4 cm with only a few cases of large accessory spleens more than 10 cm reported. 2,3 They can be distinguished from splenosis, which is the auto-transplantation of splenic tissue and formation of scattered tissue deposits that occurs secondary to abdominal trauma.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] They are most commonly diagnosed incidentally during radiological examinations performed for other reasons and generally range in size from 2 to 4 cm with only a few cases of large accessory spleens more than 10 cm reported. 2,3 They can be distinguished from splenosis, which is the auto-transplantation of splenic tissue and formation of scattered tissue deposits that occurs secondary to abdominal trauma. 1,3 The splenic tissue that becomes disseminated into the peritoneal cavity embeds itself, receiving its blood supply from neovascularity at its site of implantation.…”

Section: Discussionmentioning

confidence: 99%

“…1 The great majority of splenunculi have a silent clinical course and may remain undetected for the duration of a patient's life. 3,4 Clinical importance tends to arise in three main scenarios. 1,4 The first is if they become clinically symptomatic secondary to torsion, rupture or haemorrhage.…”

Section: Introductionmentioning

confidence: 99%

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Accessory spleen torsion: a rare cause of acute abdominal pain

Bowles

2021

Int Surg J

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Accessory spleens, which are also known as a splenunculus or a splenule, are a benign developmental anomaly in which nodules of splenic tissue exist separate to the main body of the spleen. It is a reasonably common phenomenon which is present in approximately 10-30% of the population, however they only infrequently become symptomatic. Torsion of an accessory spleen is a rare cause of abdominal pain with few cases reported in the literature, most commonly in the paediatric population. Without treatment, torsion can lead to significant complications including haemorrhagic shock, peritonitis or rupture. The rarity portends a diagnostic challenge and thus a high index of suspicion is crucial for attaining a prompt diagnosis and timely management. This case gives an account of a 43-year-old female who presented with abdominal pain secondary to a torted accessory spleen.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Accessory spleen torsion: a rare cause of acute abdominal pain

Bowles

2021

Int Surg J

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“…Preoperative diagnosis was obtained in some of the cases with CT scan, but did not change the therapeutic strategy. The common CT features are a diminished enhancement of the AS due to venous congestion, oedema in the surrounding fat and finally, signs of haemorrhagic infarction …”

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confidence: 99%

Accessory spleen torsion in a teenager

Mocanu

Vinuesa

Trayter

et al. 2014

ANZ Journal of Surgery

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migrating caval devices. 1 While ingestion of foreign bodies is common, the incidence of them requiring operative intervention is rare with figures between 1 and 14% quoted in the literature. 2,3 Most foreign bodies therefore pass freely through the gastrointestinal tract. If trapped and subsequent perforation occurs, it tends to be at areas with great angulation such as the ileocaecal valve, junctions along the duodenum, the appendix and the haustra of the large intestine. 1-3 Perforation of the duodenum remains exceedingly rare and even more so if involving nearby vascular structures. 4 Depending on the calibre of the DCF and the size, location and relative ease of removing the trapped foreign body, significant morbidity and mortality have been reported. This is secondary to overwhelming haemorrhage, sepsis and iatrogenic complications. 5 Endoscopic retrieval is one acceptable approach in the stable patient with localized perforation. 2 Due to the rarity of this presentation, there is not any evidence to compare whether open or endoscopic approach has the best outcome. This is because open management is usually associated with significant patient morbidity because of the need to mobilize and open retroperitoneal structures with consequent risk of duodenal fistulas and bleeding. Also open operation is the most common approach in the unstable patient and given the nature of this condition, it is more common that a patient would present in an unstable state and therefore undergo an open approach. Our case is one example of where endoscopic retrieval has been successful.Pulmonary embolization as a consequence of DCF has been reported even less frequently. 5 The clot lodged in the filter at time of retrieval leads us to believe that its placement in this case helped prevent and/or minimized pulmonary seeding and septic emboli.In summary, the key points of this case are that CT imaging is the diagnostic imaging of choice for foreign body perforation of the duodenum. Endoscopic retrieval can be considered in selected patients and was shown to be successful in our case. Recognizing IVC involvement and treatment with intravenous filter may minimize septic thromboembolic complications. References 1. Allen B, Krupski WC, Wylie EJ. Toothpick perforation of the inferior vena cava. West. J. Med. 1983; 138: 727-30. 2. Symeonidis D, Koukoulis G, Baloyiannis I, Rizos A, Mamaloudis I, Tepetes K. Ingested fish bone: an unusual mechanism of duodenal perforation and pancreatic trauma. A 19-year-old woman, with no significant past medical history, was admitted to the emergency ward for a 24 h non-radiated insidious abdominal pain localized in the left flank, accompanied by nausea, vomiting and low-grade fever. Physical examination revealed mild abdominal pain and tenderness in the left flank. Blood analysis showed a mild leucocytosis (14 300/mmc) and a C-reactive protein of 6.1 mg/dL; urinalysis was normal. An abdominal ultrasonography was performed, showing a mobile intraperitoneal mass, of 66 × 50 mm, adjacent to the upper pol...

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Splenopancreatic Fusion

Al-Salem

2023

The Spleen

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Torsion of an accessory spleen: Case report and review of the literature

Cited by 12 publications

References 23 publications

Accessory spleen torsion: a rare cause of acute abdominal pain

Accessory spleen torsion: a rare cause of acute abdominal pain

Accessory spleen torsion in a teenager

Splenopancreatic Fusion

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