Korean J Gastroenterol.  2021 Sep;78(3):183-187. 10.4166/kjg.2021.071.

Acute Abdominal Pain due to Accessory Splenic Infarction in an Adult: A Case Report

• Wang H
• So H
• Nah YW
• Kim M
• Lee TY
• Seo M
• Bang SJ

• KMID: 2520360
• DOI: http://doi.org/10.4166/kjg.2021.071

Abstract

Accessory spleens are common congenital anatomic variations that are usually asymptomatic. On the other hand, they can be clinically significant if complicated by hemorrhage, torsion, or infarction. This paper describes a case of an infarcted accessory spleen in a 30-year-old male who presented with abdominal pain. Abdominal CT and MRI revealed an isolated mass, 4.5 cm in size, in the perisplenic area. An infarcted accessory spleen was suspected. The patient underwent laparoscopic accessory splenectomy. Histopathology identified the mass as splenic tissue that had undergone ischemic necrosis. A definitive diagnosis of an infarcted accessory spleen was made, and the patient was discharged on day 5 after surgery symptom-free.

Keyword

Abdominal pain; Anatomic variation; Splenic infarction; Splenectomy

Figure

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  Fig. 1 (A) Ultrasound image of the accessory spleen shows a hypoechoic mass with a well-defined margin. (B) Contrast-enhanced axial computed tomography image shows a well-defined, hypo-enhancing mass, measuring approx. 4.5 cm, in the left upper quadrant of the abdomen. (C) On axial T2-weighted image, the mass appears as a solid lesion with moderate-to-high signal intensity. On contrast-enhanced MR image obtained in the (D) pre-contrast phase, (E) portal phase, and (F) subtraction image of portal phase, the tumor shows relatively high signal intensity in the pre-contrast image and no enhancement except for a subtle and thin peripheral enhancement, which is indicative of coagulative necrosis due to ischemia. (G) Technetium-99m phytate scintigraphy and single-photon emission computed tomography (SPECT) images do not show radiotracer uptake within the abdominal mass.

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  Fig. 2 (A, B) Surgical specimen after laparoscopic surgery.

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  Fig. 3 (A-D) Microscopic pathology of the surgical specimen. (A) The accessory splenic parenchyma shows decreased hematoxylin staining, and the hilar vessels show marked congestion (H&E, ×12.5). (B) The parenchyma shows diffuse necrotic changes in the red pulp (empty arrowhead) with relative sparing of the white pulp (arrowhead) (H&E, ×40). (C) The proximal splenic vessel shows luminal occlusion (arrow) (H&E, ×12.5). (D) The vessel was occluded by an organized thrombus (empty arrow) (H&E, ×40).

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