Abstract:HighlightsThis is the first reported right accessory spleen laying retro-duodenal reported.This is the second largest accessory spleen reported.Accessory spleen is a possibility in a retroperitoneal tumor differential diagnosis.We present a literature review of the other right accessory spleen cases.
“…[3][4][5]7 AS have normal splenic histology and result from the failure of splenic cell fusion during the embryologic period. 8 Its incidence varies from 10 % to 30%. 5,9 Besides, an automatic implant of normal functional splenic tissue located in any compartment of the body outside the usual position can be classically seen.…”
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 of Habib Thameur Hospital, Tunis, 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 had a laparotomy resection of the retroperitoneal mass. The result of the specimen examination was an accessory spleen. The postoperative outcome was uneventful. Conclusion: An accessory spleen on the retroperitoneal position is extremely uncommon. Preoperative diagnosis is still challenging. The main misdiagnosis was neoplastic disease.
“…[3][4][5]7 AS have normal splenic histology and result from the failure of splenic cell fusion during the embryologic period. 8 Its incidence varies from 10 % to 30%. 5,9 Besides, an automatic implant of normal functional splenic tissue located in any compartment of the body outside the usual position can be classically seen.…”
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 of Habib Thameur Hospital, Tunis, 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 had a laparotomy resection of the retroperitoneal mass. The result of the specimen examination was an accessory spleen. The postoperative outcome was uneventful. Conclusion: An accessory spleen on the retroperitoneal position is extremely uncommon. Preoperative diagnosis is still challenging. The main misdiagnosis was neoplastic disease.
“…Only nuclear medicine imaging can confirm the diagnosis with scintigraphy performed with 99mTC-labelled colloids or TC-99 m heat damaged red blood cells because the colloid labelled with TC 99 m is taken from the reticulum-endothelium and makes visible the spleen, liver and bone marrow; however, it is necessary to suspect the diagnosis of accessory spleen for this procedure [22]. Therefore, often only surgical excision can safely confirm the diagnosis [23]. For these reasons, many surgical procedures have been done for the purpose of diagnosis.…”
Section: Discussionmentioning
confidence: 99%
“…4). The remaining 17 manuscripts (8, 3%) reported 19 cases of accessory spleen (Table 1) [2, 15, 18, 20, 23–35] and were used for our manuscript.Fig. 4The flow chart of the Medline research…”
Background
The accessory spleen is a congenital defect characterized by a separated ectopic splenic parenchyma. The size is rarely more than 4 cm. The preoperative diagnosis is prohibitive preoperatively. The aims of the present manuscript were to present the case of a patient with a rare oversize accessory spleen and a review of the literature.
Case presentation
A 15-year-old boy was admitted to the emergency department following blunt abdominal trauma.
The computed tomographic scan showed a traumatic rupture of the spleen and a 7-cm mass at the left side of the retroperitoneal space. Conservative treatment started and aborted after 4 h due to the onset of haemodynamic instability. Splenectomy was performed. An accessory spleen was discovered. A second large mass in the retroperitoneum was diagnosed as a second large accessory spleen that was also left in place. The postoperative course was uneventful, and the patient was discharged on the 7th postoperative day. Seven months later, the CT scan showed viability of both accessory spleens.
Conclusion
An accessory spleen can be variously located and the retroperitoneal position is extremely uncommon. Preoperative diagnosis is still difficult, especially in emergency and as in our case, the literature shows the difficulty of reaching a diagnosis before surgery. The main misdiagnosis is neoplastic disease and for this reason accessory spleen can be wrongly removed.
An undiagnosed pre or intra operative retroperitoneal mass, closely to the spleen, have to be managed carefully. The diagnosis of accessory spleen needs to be ever considered as if found, represents a great possibility to conduct a normal life after splenectomy (of main spleen) for trauma.
“…Расположение добавочной селезёнки в правом забрюшинном пространстве представляет казуистическую редкость. В базе данных Medline опубликовано только четыре подобных клинических наблюдения [3].…”
Section: добавочная селезёнкаunclassified
“…Описаны и редкие локализации, такие как спленоренальная связка, большой и малый сальник, брыжейка тонкой кишки, придаток яичка [6]. Локализация добавочной селезёнки в правом забрюшинном пространстве -казуистическая редкость [3]. Представляем собственное клиническое наблюдение.…”
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