Splenosis Presenting as a Right Suprarenal Retroperitoneal Mass (original) (raw)
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Laparoscopic Transperitoneal Left Adrenalectomy and Wandering Spleen Risk
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2014
Background and Objectives: Laparoscopic transperitoneal left adrenalectomy (LTLA) has become the standard treatment for adrenal masses Ͻ6 cm. LTLA involves the dissection of splenic suspensory ligaments, which replicates their congenital absence or weakening, present in cases of wandering spleen (WS). WS is a rare condition in which the spleen migrates from the left upper quadrant to a more caudal location in the abdomen. A unique case of WS after LTLA was described by Corcione et al. In this prospective study, we investigated the possibility of WS as a consequence of LTLA.
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 ...
2017
Adrenal insidentalomalar sıklıkla adrenal bezle ilgisiz görüntüleme işlemlerinin ardından rastlantısal olarak bulunurlar. Aksesuar dalağa bağlı adrenal insidentaloma hastası güncel endokrin ve radyolojik yönetimle sunuldu. Elliüç yaşında erkek hasta dispeptik yakınmalar nedeniyle yapılan ultrasonografik incelemede bulunan 25x20 mm boyutlarında sol sürrenal kitle nedeniyle Endokrinoloji ünitesine sevkedildi. Hastanın biyokimyasal ve hormonal incelemeleri normal sınırlardaydı. Bilgisayarlı tomografi ve magnetik rezonans görüntülemeleri ile ayırıcı tanısı yapıldı. Görüntülerinde malignite özellikleri yoktu. Adrenal insidentaloma aksesuar dalakla uyumlu bulundu. Adrenal insidentaloma gibi görünen aksesuar dalaklı hastaların tanısal değerlendirilmesi klinik ve radyolojik yöntemlerle dikkatle yapılmalıdır.
Abdominal Splenosis -A Differential Diagnosis of Intraperitoneal Mass Citation
The first description of this benign condition was made in 1896 by Albrecht, who reported the first human case of splenosis on the peritoneum [1]. Cases of posttraumatic splenic autotransplantion following trauma or splenectomy were then reported at the beginning of the 20th century [2, 3]. The terminology “splenosis” was first used by Buchbinder and Lipkopf in 1939 [4]. In the nineties of the last century the incidence of splenosis was estimated to be 58 to 65% [5, 6]. In contrast, nowadays splenosis is a relatively rare condition. Ectopic autotransplantation has been an attempt to preserve spleen function after spleen trauma or elective splenectomy. Typically splenosis is found in the intraperitoneal cavity of the abdomen and pelvis and can even mimic tumor mass or endometriosis [7, 8].
F1000Research
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 ...
Right sided spleen laying retro-duodenal: A case report and review of the literature
International Journal of Surgery Case Reports, 2016
INTRODUCTION: Unlike left sided accessory spleen that are seen in 10-30% of cases at autopsy, cases of right accessory spleens are extremely rare. This congenital body of healthy splenic tissue simulates tumors from neighboring organs and presents a challenge in formulating a differential diagnosis. PRESENTATION OF CASE: We present the case of a patient whose CT scan of the abdomen showed a large mass, 11 × 8 cm, arising retro-duodenal and lying just anterior to the right kidney. To the best of our knowledge, this is the only case where the accessory spleen was found retro-duodenal, directly anterior to the kidney and completely separate from the supra-renal gland. The chief complaint of the patient was right upper quadrant pain, radiating to the back, and colicky in nature. The patient was diagnosed with duodenal gastro-intestinal stromal tumor and a retro-peritoneal sarcoma. The mass was removed via a Kocher's incision and immunohistological examination showed that it was a right sided accessory spleen. The patient's left sided spleen appeared normal. DISCUSSION: Efforts to distinguish an accessory spleen from a retroperitoneal tumor with available scans, percutaneous biopsy or biochemical tests are inconclusive. Differential diagnosis between a retroperitoneal tumor and an accessory spleen can only be made after surgical exploration. CONCLUSION: This case highlights the fact that surgeons should consider the possibility of an accessory spleen when making a differential diagnosis of retroperitoneal tumors.
Giant accessory spleen and rotating ectopic kidney: A rare association
World Journal of Advanced Research and Reviews, 2020
The accessory spleen is a congenital disability characterized by a separated ectopic splenic parenchyma. Wandering spleen (WS) is a rare condition where the spleen, free from its ligaments, is allowed to move inside the abdomen, predisposing the patient to life-threatening complications due to torsion of the vascular pedicle; splenic infarction, portal hypertension, bleeding and acute abdomen may occur. WS or Accessory Spleen (AS) is rarely suspected at presentation since symptoms are usually not specific, and definitive diagnosis is often reached only by imaging technologies such as color flow ultrasonography and angio-spiral computed tomography. The size is rarely more than 4cm. Patients rarely present symptoms, and the diagnosis can be accidental when faced with ectopia in radiological or intraoperative investigations. It is an essential clinical entity since abdomen-pelvic tumors must always be considered as differential diagnoses, requiring detailed evaluation. Surgical treatment is indicated for symptomatic patients or those with complications. On the other hand, the ectopic kidney with rotation abnormality also consists of a singular entity. Congenital anomalies of the upper urinary tract occur in 3%-4% of those born, most of which are followed up clinically. The present study discusses a case of symptomatic intrapelvic WS associated with an ectopic kidney with rotation anomaly, a rare union, and still with scarce reports in the literature. This study aimed to present the case of a patient with an isolated oversized accessory spleen and a review of the literature.
Unusual complication after laparoscopic left nephrectomy for renal tumour: a
Videosurgery and Other Miniinvasive Techniques, 2010
In splenic rupture after blunt trauma, iatrogenic spleen injury or non-traumatic cases it is essential that the surgeon makes correct decisions. Conservative treatment must include continual monitoring and repeated, stringent evaluation of the splenic injury (the American Association for the Surgery of Trauma-AAST) in order to avoid any delay in diagnosis of delayed spleen rupture and the high mortality it causes. We present the case of an unexpected complication after radical nephrectomy performed for renal cell carcinoma. A 61-year old man sought medical help for acute abdominal pain. He presented with some cardiovascular risk factors (diabetes mellitus, smoker of 30 cigarettes per day) and moderate alcohol use. In the Emergency Unit, computed tomography scan revealed an incidental tumour of the left kidney. Nephrectomy via the laparoscopic approach was done without any iatrogenic complications, with less than 500 cc of blood loss. Firm adhesions between the spleen and abdominal wall, which caused some minor traction that resulted in a small subcapsular haematoma, were the only surprising intraoperative finding. Within the first 6 h, the patient presented with haemodynamic instability, while the drain evacuated less than 50 cc of discharge. However, CT scan showed that subcapsular haematoma had increased to the size of 10 × 10 cm without free peritoneal fluid present. Unfortunately, 6 h later emergency surgery had to be performed due to rupture of the subcapsular splenic haematoma. Massive haemoperitoneum was evacuated and the splenic capsule was the only remnant of the spleen that could be found on re-intervention. So far, it is the first case describing an increasing subcapsular haematoma of the spleen, most likely caused by the traction of firm adhesions to the organ. We discuss means to avoid such a complication: with liberation of the adhesions, placement of a perisplenic mesh, embolization of the splenic artery or subcapsular nephrectomy. An acute splenic rupture or delayed one demands from the surgeon practical knowledge of how to prevent subcapsular haematoma and how to treat splenic rupture.