Accessory spleens: Clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura

Abstract

One of the important stages during splenectomy is the search for accessory spleens. The average frequency of accessory spleens is an estimated 11%. In our own material in 611 patients who had splenectomy in hematological disorders, accessory spleens were found in 110 patients (18%). The surgical anatomy, embryology, and clinical significance of the accessory spleens, with particular reference to the recurrence of idiopathic thrombocytopenic purpura (ITP) are discussed. The group of 177 patients with ITP treated by splenectomy 2–25 years ago is analyzed. Recurrence of thrombocytopenia after a good immediate response to splenectomy developed in 52 patients. In 13 patients the recurrence was transient, but in 19 it was longlasting. In these patients the presence of the accessory spleens was suspected by the absence of Howell‐Jolly bodies in the peripheral blood. The accessory spleen was demonstrated by splenic scan in 16 cases and confirmed in 13 of the 15 patients who underwent reoperation. Removal of the accessory resulted in permanent disappearance of thrombocytopenia in 12 patients.

Invited commentary to: „Laparoscopic splenectomy in 26 patients — A 17-months follow-up study“

“…That and the low mean intraoperative bloodloss indicates that the surgeons took perfectly advantage of the video assisted technique such as better view and more precise dissection. (6). In the present paper the rate of AS found by ultrasound or by intraoperative diagnosis was 19.2% and therefore is considerable low in comparison with published data: up to 30% in patients with hematologic diseases (5).…”

Postsplenectomy recurrence of idiopathic thrombocitopenic purpura: role of laparoscopic splenectomy in the treatment of accessory spleen

“…Lack of immediate and satisfactory post-splenectomy result or recurrence of thrombocytopenia are almost entirely connected with the remaining splenic tissue (7)(8)(9)(10)(11)(12)(13). Most authors, despite the use of different imaging techniques (ultrasonography, US; classic and spiral Computed Tomography, CT; and scintigraphy) underline the lack of reliable ways of preoperative assessment of ectopic splenic tissue (9, 10, 14, 15).…”

“…Targarona et al (20) reported the findings of an accessory spleen in 33% of the patient who had not clinical improvement after laparoscopic splenectomy for treatment of ITP. An association between the presence of missed accessory splenic tissue and recurrent or unresolved ITP after initial splenectomy has been reported (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

“…A 16 years-old Indian female patient affected by refractory ITP since she was 10 The platelet count was 1500/mmc, the WBC was 13800/mmc, hemoglobin was 9.2 g/dL. The platelet count was in progressive decreased to 1000/mmc.…”

Klinische Relevanz von Nebenmilzen nach elektiven und notfallmäßigen Splenektomien

“…Nebenmilzen können völlig unbemerkt bleiben oder klinische Bedeutung erlangen, wenn sie z.B. Lymphome oder Metastasen [19] oder einen Tumor des Magens [20][21][22], des Kolons, des Zwerchfells, der Niere, der Nebenniere [23,24] oder des Pankreas vortäuschen. Außerdem können sie durch Stieldrehung [25], Spontanrupturen [26,27], Infarkt oder Blutung [28] eine akute Bauchsymptomatik hervorrufen.…”