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A case of splenosis, or the autotransplantation of splenic tissue following trauma, was encountered unexpectedly on a routine liver scan performed in the workup of alcoholic liver disease. Confirmatory scintigraphic images using Tc-99m labeled, heat-damaged, autologous erythrocytes are presented with CT scans of the abdomen.
Intrathoracic splenosis results from the implantation of splenic tissue in the thoracic cavity following simultaneous rupture of the spleen and diaphragm. These implants may form mass lesions that lead to an extensive, costly, and invasive series of investigations, usually resulting in unnecessary surgery. The key to diagnosis is a high index of suspicion provoked by the history of a traumatic event, possibly in the distant past. This report emphasizes that because of its ability to demonstrate the functional nature of tissue, a definitive diagnosis can be made using heat-damaged Tc-99m RBCs without the need for surgical intervention.
We have presented a case of splenosis (autotransplantation of splenic tissue) after traumatic rupture of the spleen, which produced bowel obstruction. Although rarely symptomatic, these splenic implants must be considered in the differential diagnosis of abdominal pain with or without intestinal obstruction in all postsplenectomy patients. When an incidental finding at exploratory celiotomy, these implants should be preserved as a means of retaining splenic function and preventing the complication of postsplenectomy sepsis.
Splenosis or ectopic spleens were detected in 22 of 45 patients splenectomized after either abdominal trauma or accidental lesions of the spleen during operation. The incidence of ectopic spleen tissue in various groups of splenectomized patients has been investigated by a sensitive scanning method employing reinjection of 99mTc-labelled heat damaged autologous erythrocytes. In comparison 7 cases were found among 45 patients who underwent splenectomy for haematological reasons. The time span between the operation and a positive scan varied between 3 months and 11 years. None of the patients in the haematological group with reoccurrence of spleen tissue presented any signs of relapse of their primary disorder. The only patient with overwhelming infection was a girl in whom splenectomy was performed for hereditary spherocytosis. She recovered from the sepsis and her scan was negative. It is concluded that recurrence of spleen tissue is frequent after traumatic lesions of the spleen but rare after selective splenectomy for haematological reasons. This may account for the lesser tendency to overwhelming sepsis after post-traumatic splenectomy.
One case of peritoneal splenosis is reported. The diagnosis was established at surgery in a 17-year-old female patient presenting with dull abdominopelvic pain, who had undergone total splenectomy after a trauma ten years earlier. This autograft of splenic tissue must be known to be acknowledged, especially today, when the conservative treatment advocated for ruptures of the spleen may increase its incidence. The literature reports only about one hundred cases. The treatment only consists in removing the sole symptomatic nodules.
We report a case of subcutaneous splenosis in the abdominal wall of a 38-year-old woman who had suffered splenic trauma 30 years earlier. A review of the literature shows only five previous cases with subcutaneous involvement.
Thoracic splenosis is the autotransplantation of splenic tissue in the thorax after an injury of the spleen with a tear of the hemi-diaphragm. Usually, there is no symptom and it is unfrequent. A scintigraphy with 99 m. Tc. sulfur colloid and a scan with 99 m. Tc. tagged-heated red cells give the diagnosis. For now, it is no necessary to operate these patients to remove these thoracic nodules.
Intrathoracic splenosis is an unusual event after diaphragmatic and splenic rupture, which causes intrathoracic mass lesions. It results from spontaneous autotransplantation of splenic tissue to serous surfaces. On chest X-rays, three different radiological appearances were distinguished: pulmonary mass lesions, pleural lesions and mediastinal tumors. Since the radiological appearance is nonspecific, a diagnosis may only be suspected together with the characteristic anamnesis. In those case scintigraphy should be performed because this method may verify the diagnosis. Here we report the radiological and clinical appearances of this entity by one of our own and 13 well-documented cases in the literature.
A clinical case of splenosis recently observed in a young man subjected at the age of 8 to splenectomy for rupture of the spleen and operated at 19 for intestinal occlusion is reported. The pathogenetic aspects of the condition, characterised by the presence of nodules of splenic tissue in the abdominal cavity, are examined through a review of the literature.
Incidental discovery of a mass during laparoscopic surgery resulted in exploratory laparotomy for a young woman. The mass' uncharacteristic appearance belied its true identity as displaced splenic tissue. The authors suggest ways to identify splenosis without resorting to further surgery.
Ten patients who had been splenectomized for trauma between 1 and 11 years previously were studied by computed tomography (CT) and radionuclide scanning with 99Tcm tin colloid on the same day. Computed tomography detected splenic tissue in three patients. Radionuclide scanning detected splenic tissue in eight patients, including two cases of typical splenosis not identified by CT. Radionuclide scanning was found to be more sensitive in the detection of residual splenic tissue than CT.
Three different noninvasive imaging procedures were performed in a patient after an intravenous pyelogram suggested a suprarenal mass. Presence of a mass was confirmed by ultrasonogram. Computed tomography revealed two masses in the splenic bed that showed contrast enhancement. Radionuclide scans demonstrated multiple splenic masses (splenosis). The specificity of the splenic tissue as well as the anatomic resolution were best with the radionuclide liver and spleen scan.
A case of pelvic splenosis is presented to discuss preoperative investigation and to describe surgical difficulties that may be encountered. Surgery should only be undertaken when warranted by troublesome symptoms. Removal of asymptomatic ectopic splenic tissue is contraindicated.
This article does not deal with the general problem of splenosis, but with the pathology of splenic nodules implanted in the peritoneum. This condition is uncommon, and chiefly hematological and infectious in the index case. Although this issue is debated, functional activity of these nodules is substantiated, leading to consider therapeutical applications in some exceptional cases.
A case of regenerated splenosis 20 years after splenectomy masquerading as a gastric fundic mass is reported. Several endoscopic examinations revealed an extramucosal extrinsic mass in the gastric fundus and a chain of small ulcers high along the lesser curvature. Radionuclide technetium scan and CT scan accurately detected the regenerated splenic tissue indenting the gastric fundus and thus obviated the need for angiography and exploratory surgery.
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A 28-year-old male medical student underwent splenectomy at 8 years of age due to traumatic rupture of the spleen sustained in a motor vehicle accident. Eighteen years later the patient had major abdominal surgery performed for an unrelated condition and, at the time of surgery, over 100 splenic nodules were found embedded throughout the patient's omentum, small bowel, and mesentery. An extensive study of immunological functions was carried out during the following 2 years. Through the course of this investigation, it was determined that the patient's peripheral blood smear lacked Howell-Jolly bodies and deformed or damaged erythrocytes, indicating that the splenotic tissue had the capacity to remove intranuclear inclusions from circulating red cells and to phagocytose old erythrocytes. The patient's levels of complement, serum immunoglobulins and the numbers of circulating T and B lymphocytes, helper T cells, and cytotoxic/suppressor T cells all were within the normal range. The response to Streptococcus pneumoniae polysaccharides was also normal, with increased levels of specific antibodies to all serotypes included in the vaccine 4 months after immunization. Finally, histological examination of his biopsied splenotic nodules revealed tissue that was indistinguishable from normal spleen.