Pelvic splenosis—a very unusual location

Abstract

We present a rare case of pelvic splenosis, and its imaging findings, in a 54-year-old female complaining of pelvic pain and vaginal bleeding for several months. Splenosis is a benign acquired condition defined as heterotopic auto-transplantation of splenic tissue to other compartments of the body and occurs after rupture of the spleen, either traumatic or iatrogenic. Symptoms are unspecific and vary according to the location of the implants; commonly the presenting symptom is abdominal pain or enlarging abdominal mass. Owing to its intrinsic properties and safety, magnetic resonance imaging is a valuable imaging modality, in which the splenosis implants may be securely identified, showing the same signal characteristics and enhancing patterns of the normal spleen, especially visualization of serpiginous enhancement on the arterial phase is virtually diagnostic.

Cul-de-sac splenosis - An unusual location

“…It has been estimated to develop in up to 67% of patients with traumatic splenic rupture [1,4]. The pathogenesis of splenosis is primarily due to the rupture of the splenic capsule and seeding of splenic tissue in nearby body cavities [1,4,5].…”

“…Splenosis is commonly asymptomatic and is incidentally found on routine imaging or during surgery [1]. Splenosis at a first glance can be concerning for a neoplastic process [5].…”

“…If it occurs in the pelvis, pelvic pain, dysmenorrhea or other gynecologic symptoms may occur [8]. Pelvic splenosis can be especially hard to diagnosis because of the many gynecological conditions such as leiomyomas, endometriosis and other neoplastic processes [1,4]. Splenosis and endometriosis share diffuse peritoneal spread and differ in intraperitoneal adhesions splenosis [9].…”

“…Splenosis could also be confused with accessory spleens [4]. However, in contrast to an accessory spleen, splenosis derives its blood supply from nearby vessels [1]. Furthermore accessory spleens are usually found near the splenopancreatic or gastrosplenic ligament [10].…”

“…It commonly occurs after splenic rupture due to trauma or surgery [1]. The majority of the cases are asymptomatic and incidentally found on routine imaging.…”