Spleen: Developmental Pathology

Accessory Spleen

Definition

  • An Additional Segment of Splenic Tissue at an Ectopic Site
  • Prevalence: 10-30%

Locations

  • Splenic Hilum (75%) – Most Common
  • Pancreatic Tail (20%)
  • Greater Omentum
  • Along the Splenic Artery
  • Gastrosplenic Ligament
  • Splenocolic Ligament
  • Retroperitoneum
  • Greater Curve of the Stomach
  • Gastrocolic Ligament
  • Small Bowel Mesentery

Presentation

  • Usually Asymptomatic
  • Often Seen as ITP Relapse After Splenectomy
  • Risk for Torsion

Evaluation

  • First Step in Evaluation After Splenectomy: Peripheral Blood Smear
    • *Howell-Jolly Bodies will Be Absent – Only Present in Complete Asplenia
  • To Locate: Radiolabeled RBC Scan

Accessory Spleen 1

Wandering Spleen

Basics

  • Also Known as Displaced Spleen, Drifting Spleen or Splenic Ptosis
  • Absence or Weakness of Ligaments & Peritoneal Attachments
    • Can “Wander” Presenting Ectopically in Lower Abdomen/Pelvis

Presentation

  • Presentation: Usually Asymptomatic
  • Risk for Torsion

Diagnosis

  • Dx: US or CT (Noncontrasted or Whorled Pedicle Indicates Torsion)

Treatment

  • Incidental/Not Infarcted: Splenopexy to LUQ
  • Infarcted: Splenectomy

Splenic Torsion 2

References

  1. Gundogdu K, Altintoprak F, Uzunoğlu MY, Dikicier E, Zengin İ, Yağmurkaya O. Coexisting Situs Inversus Totalis and Immune Thrombocytopenic Purpura. Case Rep Surg. 2016;2016:8605673. (License: CC BY-4.0)
  2. Ozeki M, Asakuma M, Go N, Ogura T, Inoue Y, Shimizu T, Hirokawa F, Yamamoto K, Hayashi M, Narumi Y, Higuchi K, Uchiyama K. Torsion of an accessory spleen: a rare case preoperatively diagnosed and cured by single-port surgery. Surg Case Rep. 2015 Dec;1(1):100. (License: CC BY-4.0)