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Torsion of an accessory spleen: a rare case preoperatively diagnosed and cured by single-port surgery

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ABSTRACT

We report a very rare case of acute abdomen caused by torsion of an accessory spleen that was preoperatively diagnosed and cured by single-port surgery. A 31-year-old woman was admitted to our hospital with severe left abdominal pain. Physical examination revealed a left upper quadrant abdominal tenderness with voluntary guarding. Ultrasound demonstrated a well-defined round mass isoechoic to the spleen, measuring 3.0 cm in diameter in the left upper quadrant adjacent to the spleen. A contrast-enhanced CT scan showed a normally enhanced spleen and a 3.0 × 3.0, hypodense, non-enhancing mass anterior to the spleen with a twisted funicular structure. Torsion of an accessory spleen was suspected, and emergency single-port surgery was performed. During surgery, a rounded violet mass measuring 3.0 cm in diameter, suggestive of an accessory spleen, with a 1800° torsion around a long vascular pedicle along the left side of the greater omentum was discovered. The mass was removed and post-operative recovery was uneventful. A review of the literature revealed 26 cases (including ours) of torsion of an accessory spleen in English. Even with the recent advances in radiologic imaging modalities, making a preoperative diagnosis of this is difficult and most cases are diagnosed during laparotomy. This is the first report preoperatively diagnosed and cured by single-port surgery. We decided to start the operation by using a single port, not only for cosmetic reasons for this young female patient, but also for final confirmation of our diagnosis. We believe that single-port laparoscopy is valuable as a diagnostic tool as long as safety is assured for patients with acute abdomen. Although torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in children and young adults.

Electronic supplementary material: The online version of this article (doi:10.1186/s40792-015-0101-x) contains supplementary material, which is available to authorized users.

No MeSH data available.


Post-operative abdomen. It shows a scarless result by single-port laparoscopic surgery
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Fig4: Post-operative abdomen. It shows a scarless result by single-port laparoscopic surgery

Mentions: The operation was performed by single-port laparoscopy. Surgical glove method with a 1.5-cm umbilical incision was used, as we have previously reported [4, 5]. Operative findings revealed that the main spleen was normal. A rounded violet mass measuring 3.0 cm in diameter, suggestive of an accessory spleen, with a 1800° torsion around a long vascular pedicle along the left side of the greater omentum was discovered. The mass and its pedicle were removed easily, using Surgitie™ loop (Fig 3). The specimen was retrieved by Endo Catch™. Figure 4 shows the post-operative abdomen.Fig. 3


Torsion of an accessory spleen: a rare case preoperatively diagnosed and cured by single-port surgery
Post-operative abdomen. It shows a scarless result by single-port laparoscopic surgery
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596154&req=5

Fig4: Post-operative abdomen. It shows a scarless result by single-port laparoscopic surgery
Mentions: The operation was performed by single-port laparoscopy. Surgical glove method with a 1.5-cm umbilical incision was used, as we have previously reported [4, 5]. Operative findings revealed that the main spleen was normal. A rounded violet mass measuring 3.0 cm in diameter, suggestive of an accessory spleen, with a 1800° torsion around a long vascular pedicle along the left side of the greater omentum was discovered. The mass and its pedicle were removed easily, using Surgitie™ loop (Fig 3). The specimen was retrieved by Endo Catch™. Figure 4 shows the post-operative abdomen.Fig. 3

View Article: PubMed Central

ABSTRACT

We report a very rare case of acute abdomen caused by torsion of an accessory spleen that was preoperatively diagnosed and cured by single-port surgery. A 31-year-old woman was admitted to our hospital with severe left abdominal pain. Physical examination revealed a left upper quadrant abdominal tenderness with voluntary guarding. Ultrasound demonstrated a well-defined round mass isoechoic to the spleen, measuring 3.0 cm in diameter in the left upper quadrant adjacent to the spleen. A contrast-enhanced CT scan showed a normally enhanced spleen and a 3.0 × 3.0, hypodense, non-enhancing mass anterior to the spleen with a twisted funicular structure. Torsion of an accessory spleen was suspected, and emergency single-port surgery was performed. During surgery, a rounded violet mass measuring 3.0 cm in diameter, suggestive of an accessory spleen, with a 1800° torsion around a long vascular pedicle along the left side of the greater omentum was discovered. The mass was removed and post-operative recovery was uneventful. A review of the literature revealed 26 cases (including ours) of torsion of an accessory spleen in English. Even with the recent advances in radiologic imaging modalities, making a preoperative diagnosis of this is difficult and most cases are diagnosed during laparotomy. This is the first report preoperatively diagnosed and cured by single-port surgery. We decided to start the operation by using a single port, not only for cosmetic reasons for this young female patient, but also for final confirmation of our diagnosis. We believe that single-port laparoscopy is valuable as a diagnostic tool as long as safety is assured for patients with acute abdomen. Although torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in children and young adults.

Electronic supplementary material: The online version of this article (doi:10.1186/s40792-015-0101-x) contains supplementary material, which is available to authorized users.

No MeSH data available.