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| LETTER TO EDITOR |
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| Year : 2022 | Volume
: 13
| Issue : 4 | Page : 258-259 |
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Accessory spleen torsion simulating acute appendicitis
Yurisiel Montero Verdecia, Fernando Karel Fonseca Sosa, Yurisel Sánchez Pompa, Miriela Lisbet León Fonseca
Department of General Surgery, Celia Sánchez Manduley Hospital, Manzanillo, Granma, Cuba
| Date of Submission | 24-Feb-2022 |
| Date of Decision | 25-Feb-2022 |
| Date of Acceptance | 26-Feb-2022 |
| Date of Web Publication | 18-Oct-2022 |
Correspondence Address:
Dr. Fernando Karel Fonseca Sosa
Esperanza Street #73 between Guadalupe and San Javier, Manzanillo, Granma 87510
Cuba
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/injms.injms_24_22
How to cite this article:
Montero Verdecia Y, Fonseca Sosa FK, Sánchez Pompa Y, León Fonseca ML. Accessory spleen torsion simulating acute appendicitis. Indian J Med Spec 2022;13:258-9 |
How to cite this URL:
Montero Verdecia Y, Fonseca Sosa FK, Sánchez Pompa Y, León Fonseca ML. Accessory spleen torsion simulating acute appendicitis. Indian J Med Spec [serial online] 2022 [cited 2023 Jun 7];13:258-9. Available from: http://www.ijms.in/text.asp?2022/13/4/258/358773 |
Dear Editor,
Accessory spleen (AS) is defined as ectopic splenic tissue that develops due to the failure of cell fusion during embryonic development while migrating from the midline to the left upper quadrant. AS includes isolated spleen tissue outside the normal spleen.[1] AS torsion is a very rare condition often difficult to diagnose and is commonly an unexpected finding when operating on patients with acute abdominal findings.[2]
We present the case of a 21-year-old male who came to the emergency department for abdominal pain that began 1 day ago in the mesogastrium and then moved to the lower right quadrant, which intensified progressively, was constant, without radiation, did not relieve with pain relievers, it was accompanied by anorexia and nausea and increased with the realization of sudden movements.
On physical examination, the patient had tachycardia of 102 beats/min and a fever of 38.5°C. Examination of the abdomen revealed pain on superficial and deep palpation in the lower right quadrant, with muscular defense and peritoneal reaction. Laboratory tests showed leukocytosis (12 × 109/l), with neutrophilia (85%), and the rest of the tests were normal. In imaging techniques, abdominal ultrasound (US) did not help make the diagnosis.
Emergency intervention was performed by McBurney incision, identifying a normal cecal appendix. At 60 cm from the ileocecal valve next to the mesenteric border of the jejunal loop, it was identified an ischemic AS of approximately 4 cm with torsion of the vascular pedicle [Figure 1]. AS was resected without difficulty. Histology examination of the resected specimens revealed splenic tissue with areas of infarction. The patient evolved satisfactorily and was discharged on the 3rd postoperative day. | Figure 1: Intraoperative picture showing ischemic accessory spleen next to the mesenteric border of the jejunal loop
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AS is asymptomatic and rarely causes clinical symptoms. However, in some cases, may present with symptoms related to torsion and infarction. Affected patients range from infants to the elderly, with more than half of the reported cases in children.[2]
The presence of more than one spleen may be found in the supracolic compartment along the splenic artery, in the greater gastric curvature, or around the suspensory ligaments of the spleen, but small ASs (splenunculus) may be found in the greater and lesser omentum, in the mesenteries and next to the genital organs.[3]
Computed tomography (CT) scan and magnetic resonance imaging play an important role in the diagnosis of AS. US examination gives the possibility to suspect a pathology of the AS. However, in some cases, the US evaluation of increased echogenicity of fatty mesenteric tissue may be difficult to appreciate, whereas the increased density of mesenteric fat can be quite easily and definitely demonstrated by CT scan.[4]
Reported complications of an AS are torsion around the vascular pedicle or hemorrhage due to rupture. Other complications such as intestinal obstruction, infection, and peritonitis have been less commonly reported. However, complications such as torsion or hemorrhage of ASs usually present as a surgical emergency and need surgery on an urgent basis. Resection of the AS should be performed by conventional or video laparoscopic surgery.[5]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
None.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Palumbo V, Mannino M, Teodoro M, Menconi G, Schembari E, Corsale G, et al. An extremely rare case of an oversized accessory spleen: Case report and review of the literature. BMC Surg 2019;19:45-51.  |
| 2. | Yoshida M, Saida T, Masuoka S, Urushibara A, Chiba F, Masumoto K. Preoperative diagnosis of a torsioned accessory spleen. J Med Ultrasound 2021;29:116-8. [Full text] |
| 3. | Sisto Díaz A, Sierra Enrique EN. Surgical affections of the spleen. In: Soler Vaillant R, Mederos Curbelo ON, editors. Surgery. Habana: Ecimed; 2018. p. 165. |
| 4. | Trinci M, Ianniello S, Galluzzo M, Giangregorio C, Palliola R, Briganti V, et al. A rare case of accessory spleen torsion in a child diagnosed by ultrasound (US) and contrast-enhanced ultrasound (CEUS). J Ultrasound 2019;22:99-102. |
| 5. | Sheth H, Chaudhari S, Sinha Y, Prajapati R. Infarcted accessory spleen masquerading as a mesenteric cyst. BMJ Case Rep 2018;2018:92-8. |
[Figure 1]
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