Diagnostic challenge for giant left retroperitoneal accessory spleen: a case report

Li, Youjian; Qiu, Xuefeng; Li, Weijian; Guo, Hongqian; Li, Xiaogong

doi:10.1177/0300060519875898

Cited by 7 publications

(10 citation statements)

References 7 publications

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“…In our case, imaging ndings of the retroperitoneal mass led to misdiagnose of the accessory spleen. They showed that the principal supply artery of the lesion was native of the left common iliac artery instead of the splenic artery according to the literature (11). On the other hand, the size of the mass in our case was too much larger than reported in the literature, and its enhancement scanning pattern was different from the main spleen.…”

Section: Discussioncontrasting

confidence: 55%

“…Nowadays, Only nuclear medicine imaging can con rm the diagnosis using Technetium-99m heatdamaged red blood cell scintigraphy or Tc-99m heat-damaged autologous red blood cell SPECT-CT which are the key mean to differentiate accessory splenic tissue (3,(11)(12)(13). This modality concludes approximately the site of the accessory spleen, but is only performed when there is a high suspicious index (13,14).…”

Section: Discussionmentioning

confidence: 99%

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Challenging diagnostic of an accessory spleen mimicking a retroperitoneal tumor: A case report and review of the literature

Zouaghi

Miri

Mesbahi

et al. 2022

Preprint

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Background: The accessory spleen is a congenital defect with an additional splenic tissue to the native spleen due to an incomplete fusion of splenic masses during the embryologic period. The preoperative diagnosis is usually mistaken for a retroperitoneal neoplasm. The aim of the present manuscript is to highlight the diagnostic difficulties of a retroperitoneal spleen. Case presentation: A 41-year-old woman was admitted to the surgical department for an abdominal mass discovered by auto palpation associated with a left lower quadrant pain. The computed tomographic scan showed a heterogeneous and partially necrotic retroperitoneal mass located along the left primitive iliac vessels. Arterial supply to the mass arose from the aorta and the left iliac vessel. The spleen was normal. MRI examination showed a left retroperitoneal heterogeneous and necrotic mass, surrounding the iliac vessels extended from the aortic to the left iliac bifurcation, hyper vascularized at the arterial time with a peripheral capsule intensely enhanced, and there were two other lateroaortic vascularized masses. The patient underwent laparotomy resection of the retroperitoneal mass. The examination of the specimen concluded to an accessory spleen. The postoperative course was uneventful. Conclusion: An accessory spleen on the retroperitoneal position is extremely uncommon. Preoperative diagnosis is still challenging. The main misdiagnosis is neoplastic disease.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Challenging diagnostic of an accessory spleen mimicking a retroperitoneal tumor: A case report and review of the literature

Zouaghi

Miri

Mesbahi

et al. 2022

Preprint

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“…[ 4 ] At the fifth week of embryonic development, an accessory spleen may form if the embryo spleen bud is not fully fused or if a single cell is separated from the body of the spleen. [ 5 ] An accessory spleen is a congenital defect, [ 6 ] 1 to 3 pieces, about 1.0 cm in diameter, normally located in the left upper abdomen, around the normal spleen. Abnormally enlarged accessory spleen may be found after splenectomy with or without hypersplenism.…”

Section: Introductionmentioning

confidence: 99%

Rare case of upper gastrointestinal hemorrhage due to accessory spleen: A case report

et al. 2022

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Rationale: Upper gastrointestinal hemorrhage (UGIH) is defined as hemorrhage originating from the gastrointestinal tract proximal to the ligament of Treitz. The causes of UGIH include esophagitis, gastritis, peptic ulcers, Mallory-Weiss syndrome, and cancer. However, a rare cause of UGIH, such as an accessory spleen, may lead to serious complications if left untreated and can sometimes be very difficult to diagnose preoperatively.Patient concerns: An 18-year-old man was admitted to the Department of Gastroenterology of our hospital due to "repeated black stool for 2 months with aggravation, accompanied by hematemesis for 9 days." He denied any history of hepatitis, trauma, or surgery.Diagnosis: Laboratory evaluation revealed severe anemia (hemoglobin, 6.4 g/dL). Computed tomography revealed a mass measuring 127 mm in its largest dimension, located in the upper left abdomen, with varicose veins in the gastric fundus. Moreover, distended blue-purple tortuous veins were observed by gastroscopy in the gastric fundus. We believed the mass was likely an abnormally proliferating accessory spleen; however, the causes of severe anemia and gastrointestinal hemorrhage were unknown.Interventions: After discussion in a multidisciplinary conference, the mass was completely resected laparoscopically, and the subserosal veins in the gastric fundus were sutured using absorbable threads.Outcomes: After the surgery, the patient recovered uneventfully without any complications. Clinicopathological examination showed that the mass was chronic congestive splenomegaly. Gastrointestinal hemorrhage secondary to an abnormally proliferating accessory spleen was confirmed as the diagnosis. Laboratory evaluation revealed hemoglobin at 12.1 g/dL 2 months after surgery. At the 12-month follow-up, the patient showed no recurrence of gastrointestinal hemorrhage.Lessons: UGIH caused by accessory spleen is extremely rare. This entity should be considered in differential diagnosis of gastrointestinal hemorrhage. Surgical intervention is necessary for timely diagnosis and treatment in case of gastrointestinal hemorrhage in critical clinical situations.

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“…The spleen is derived from mesenchymal cells of the dorsal mesentery,and appears approximately at the sixth week of embryologic life [ 1 , 2 ]. The spleen is located between the 9th and 11th left ribs in abdominal cavity, between the gastric bottom and the left diaphragm.…”

Section: Introductionmentioning

confidence: 99%

“…With a weight of approximately 200 g, it represents the largest lymphoid organ in the body [ 3 ]. At the fifth week of embryonic development, an accessory spleen may form if the embryo spleen bud is not fully fused or its single cell is separated from the body of the spleen, which is a congenital defect [ 2 , 4 ]. Accessory spleen is common and typical in most imaging manifestations.…”

Section: Introductionmentioning

confidence: 99%

An extremely rare case of a gastric accessory spleen: case report and review of the literature

Chen

Zhang

2021

BMC Gastroenterol

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Background The accessory spleen has no anatomical or vascular relationship with the normal spleen, The tissue structure and physiological function of the accessory spleen are the same as those of the normal spleen, which usually locate in the splenic hilum and the tail of the pancreas. The aims of this manuscript are to present a rare case of the gastric accessory spleen and a review of the literature. Case presentation A 19-year-old male patient was sent to the emergency department with stomach bleeding after drinking alcohol. The computed tomographic scan showed a 1.2 cm × 1.7 cm mass at the lesser curvature of the gastric fundus. Gastrointestinal endoscopy displayed a submucosal elevated lesion on the gastric fundus, and gastrectomy was performed. Postoperative pathological examination proved an accessory spleen in the stomach. The postoperative course was uneventful, and the patient was discharged on the 6th day after the surgery. Conclusions The accessory spleen at the fundus of stomach is extremely rare, especially in this case, which is accompanied by acute gastric bleeding, and it is difficult to diagnosis before operation. Many literatures reported that it was misdiagnosis as tumor, so it is necessary to diagnose accessory spleen correctly.

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Diagnostic challenge for giant left retroperitoneal accessory spleen: a case report

Cited by 7 publications

References 7 publications

Challenging diagnostic of an accessory spleen mimicking a retroperitoneal tumor: A case report and review of the literature

Challenging diagnostic of an accessory spleen mimicking a retroperitoneal tumor: A case report and review of the literature

Rare case of upper gastrointestinal hemorrhage due to accessory spleen: A case report

An extremely rare case of a gastric accessory spleen: case report and review of the literature

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