Clinicopathologic analysis of epidermoid cyst in intrapancreatic accessory spleen: a report of 12 cases / 中华胰腺病杂志

Objective:To explore the clinical and pathological characteristics of epidermoid cyst in intrapancreatic accessory spleen (ECIPAS).Methods:The clinical and pathological data on 12 cases of confirmed ECIPAS in the First Affiliated Hospital of Naval Medical University and Huashan Hospital Affiliated to Fudan University from January 2011 to December 2020 were retrospectively analyzed. Patients′ sex, age, serum tumor markers, tumor size, tumor location and distant metastasis were recorded. Tissue expression of synaptophysin (Syn), chromogranin A(CgA), cytokeratin (CK) and CK5/6, estrogen receptor (ER), progesterone receptor (PR), proliferation index Ki-67 and tumor suppressor gene p53 were evaluated by immunohistochemistry.Results:All the patients were incidentally diagnosed during routine body examination. Among them, there were 4(33.3%) men and 8(66.7%) women. Patient's average age was 42 years old. All the lesions were located at the tail of the pancreas. 3 patients had elevated carbohydrate antigen 19-9(CA19-9). The ECIPAS were demonstrated as clear-boundary low or no echo on abdominal ultrasound, low-density mass on CT, and cystic and solid lesion on pancreas MRI, respectively. Eleven patients received resection of body and tail of pancreas and spleen, one patient received pancreatectomy with preservation of the spleen. The resected specimens from the 12 patients were showed as cystic and solid mass in the pancreatic tail with a maximal diameter ranging from 1.4 cm to 4.0 cm. Under microscopy, multi-cystic lesions covered with stratified squamous epithelial cells were observed. Immunohistochemistry showed that the squamous cell marker CK was expressed. In a follow-up period of 5 to 119 months, and no recurrence were diagnosed.Conclusions:ECIPAS is a rare lesion often occurring in tails of pancreas and the patients usually have no clinical symptoms. It is challenging to make a correct diagnosis by imaging, but this lesion has unique pathological manifestations and good prognosis.

Bazo accesorio secundario a trombocitopenia autoinmune primaria refractaria - Un reto diagnóstico / Accessory spleen resection in refractory primary autoimmune thrombocytopenia - a diagnostic challenge

Resumen En la trombocitopenia autoinmune primaria hay formación de autoanticuerpos contra las membranas plaquetarias causando destrucción plaquetaria esplénica y compromiso clínico consistente en petequias, hemorragias y trombocitopenia. Cuando falla el manejo médico con corticoides e inmunoglobulinas está indicada la realización de esplenectomía, que funciona para remisión parcial de la enfermedad persistente. Realizar la esplenectomía hace necesario el estudio de un bazo accesorio o material esplénico recurrente, que comúnmente se asocia con la pobre respuesta a tratamiento y recaídas de la enfermedad. Se presenta el caso de una paciente de 27 años y antecedentes de trombocitopenia autoinmune primaria quien requirió esplenectomía, con adecuada evolución postoperatoria y remisión de los síntomas por dos años. Posteriormente, presentó recaída clínica y paraclínica, con plaquetas en 11 000 cel/uL, en contexto de trombocitopenia severa sintomática, presencia de gingivorragia, petequias en los miembros inferiores y el abdomen. Se realizó búsqueda activa de bazo supernumerario por medio de estudios complementarios, los cuales evidenciaron bazo accesorio localizado en el ligamento gastro cólico, que fue resecado por vía laparoscópica, con adecuada respuesta y remisión sintomática de la trombocitopenia autoinmune primaria refractaria. En pacientes esplenectomizados con púrpura trombocitopénica idiopática que tengan recaída de su enfermedad se requiere búsqueda activa de bazos supernumerarios, puesto que es una causa frecuente de su reaparición.

Abstract In primary autoimmune thrombocytopenia there is formation of autoantibodies against the splenic platelet membranes causing platelet destruction with clinical deterioration consisting of petechiae, haemorrhages and thrombocytopenia. When the medical management with corticoids and immunoglobulins fails, it is indicated the accomplishment of splenectomy that works for partial remission of the persistent disease. Performing splenectomy requires the study of an accessory spleen or the recurrent splenic material, that is commonly associated with poor response to treatment and frequent relapses of primary autoimmune thrombocytopenia. A case is presented in a 27-year-old patient with a history of primary autoimmune thrombocytopenia requiring splenectomy, with adequate postoperative evolution and remission of symptoms for two years who later presents clinical and paraclinical relapse with platelets at 11,000 cells/uL in the context of severe symptomatic thrombocytopenia, with the presence of gingivorrhagia, petechiae in the lower limbs and abdomen. Active search of supernumerary spleen was performed by means of complementary studies that showed an accessory spleen located in the gastrocolic ligament, which was resected by laparoscopy with adequate symptomatic remission response of the refractory primary autoimmune thrombocytopenia. In splenectomized patients with idiopathic thrombocytopenic purpura who have relapsed their disease, they require an active search for supernumerary spleens since it is a frequent cause of their reappearance.

Presencia y biometría de bazo accesorio en individuos chilenos: estudio por tomografía computarizada / Presence and biometry of accessory spleen in Chilean individuals: study by computerized tomography

El bazo se localiza en el cuadrante superior izquierdo del abdomen, relacionándose posteriormente con la 9a a 11a costilla, de las que se separa por el diafragma y el receso costodiafragmático, se localiza por detrás del estómago y lateralmente al riñón izquierdo. Por alteraciones en su desarrollo pueden generarse bazos accesorios (BA), considerándose un tejido ectópico del bazo. Se consideran tejido normal, con los mismos procesos fisiológicos que el bazo principal. Con el propósito de localizar y determinar aspectos biométricos de los mismos, se realizó un estudio de corte transversal y de carácter descriptivo, sobre una muestra de 220 exámenes de TC pertenecientes a pacientes mayores de 18 años del Hospital Regional Hernán Henríquez Aravena, Temuco, Chile. Para este estudio se excluyeron toda aquellas TC con antecedentes de esplenectomía y lesiones de Bazo o peri-esplénicas. El análisis de los datos mostró una prevalencia de 32,3 % de BA, pudiendo ser de una única presencia, dos e incluso tres BA por paciente.De un total de 71 personas que tienen al menos un BA, 34 (47,89 %) fueron de sexo femenino y 37 (52,11 %) de sexo masculino. Hubo 56 pacientes (78,9 %) con un BA, 29 (40,85 %) del sexo femenino y 27 (38,03 %) del masculino; 15 (21,1 %) presentaron más de un BA, 5 (7,04 %) de sexo femenino y 10 (14,08 %) de sexo masculino, si bien se puede observar variación en la cantidad de BA según sexo, no existe una relación estadísticamente significativa entre dichas variables. La ubicación más frecuente encontrada en el plano axial fue la zona antero-medial con 59 casos (66,29 %); asimismo, en el plano sagital, la localización más frecuente fue en el polo inferior con 40 casos (44,44 %). Datos biométricos de estos BA son mostrados en Tablas. Esta información será de gran valor morfológico y médico debido a la escasa literatura existente sobre esta materia en individuos chilenos.

The spleen is located in the upper left quadrant of the abdomen, subsequently related to the 9th to 11th rib, from which it is separated by the diaphragm and the cost-diaphragmatic recess, it is located behind the stomach and laterally to the left kidney. Due to alterations in its development, accessory spleens (AS) can be generated, being considered an ectopic tissue of the spleen. The AS are considered normal tissue, with the same physiological processes as the main spleen. With the purpose of locating and determining biometric aspects of them, a cross-sectional and descriptive study was carried out on a sample of 220 CT scans belonging to patients over 18 years of age at the Hernán Henríquez Aravena Regional Hospital, Temuco, Chile. For this study, all CT scans with a history of splenectomy and spleen or peri-splenic lesions were excluded. The analysis of the data showed a prevalence of 32.3 % of AS, being able to be of a single presence, two and even three AS per patient. Of a total of 71 people who have at least one AS, 34 (47.89 %) were female and 37 (52.11 %) male. There were 56 patients (78.9 %) with a one AS, 29 (40.85 %) of the female sex and 27 (38.03 %) of the male; 15 (21.1 %) presented more than one AS, 5 (7.04 %) female and 10 (14.08 %) male, although variation in the amount of AS according to sex can be observed, no there is a statistically significant relationship between these variables. The most frequent location found in the axial plane was the anteromedial zone with 59 cases (66.29 %); also, in the sagittal plane, the most frequent location was in the lower pole with 40 cases (44.44 %). Biometric data of these AS are shown in tables. This information will be of great morphological and medical value due to the limited existing literature on this subject in Chilean individuals.

Clinical and pathological characteristics of abdominal ectopic spleen: 13 cases report / 解放军医学杂志

Objective To analyze the clinical manifestation, diagnosis and pathological features of abdominal ectopic spleen (AES) cases. Methods The clinical and pathological characteristics were retrospectively analyzed along with the followup data of patients diagnosed as AES in the Changhai Hospital affiliated to Naval Medical University from Jan. 2013 to Dec. 2018. Results A total of 13 cases of AES were diagnosed, of whom 7 cases (53.8%) were found due to medical examination, and only one case was diagnosed before operation, while the rest were considered as having tumor of the abdominal organ near the mass. Out of the 13 cases, the AES in 6 cases were located at the pancreas tail. The surgical excision samples showed an appearance of nodular lesion with clear contour, and the structure of spleen parenchyma could be identified under microscope. Among the 13 cases, spleen trabecular and obvious central arterioles were absent in 2 cases with history of surgery, while the rest 11 cases shared the pathological features of spleen trabecular, central arterioles and secondary follicles. All the 13 patients survived except one died due to progression of gastric cancer and another one missing of follow-up. Conclusions The AES lacks specific clinical features, which requires antidiastole with abdominal tumors. It is inferred from clinicopathological features that splenosis may differ from accessory spleen, that is, splenosis may lack typical spleen white pulp.

Analysis of misdiagnosis and mistreatment of epidermoid cyst in intrapancreatic accessory spleen / 中华胰腺病杂志

Objective@#To investigate the imaging characteristics and the cause for the misdiagnosis and mistreatment of epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) in order to improve the accuracy of preoperative diagnosis.@*Methods@#The clinical and imaging data of 8 patients with ECIPAS confirmed by pathology in Zhejiang Provincial People′s Hospital between June 2008 and February 2018 were collected. The reason for doctor visit included CA19-9 elevation (n=1) and pancreatic occupying mass (n=9) during physical examination and no obvious symptoms were reported. CT and MRI imaging features, diagnosis and treatment were analyzed.@*Results@#The lesions in 8 cases of ECIPAS were all located in the tail of the pancreas and were cystic and solid. The lesions in 3 cases were mainly cystic and the cystic wall was linear, whose CT density, MRI signal and enhancement pattern cannot be compared with those of the spleen. Solid components can be seen in 5 cases, and the CT density or MR signal of the solid part was similar to that of the spleen. After enhancement, the solid part at the artery stage was uniformly enhanced and the enhancement degree was higher than that of the pancreas. Similar to the spleen, it was uniformly enhanced at the portal vein stage and the enhancement degree of the spleen was consistent. All 8 patients were diagnosed with pancreatic neoplastic lesions before surgery, and 1 patient had pancreatic fistula and peripancreatic necrosis after surgery. Postoperative pathology confirmed the diagnosis of ECIPAS.@*Conclusions@#Improving the radiologists and clinicians′ cognition of the imaging manifestations of ECIPAS can improve the accuracy of preoperative diagnosis and avoid unnecessary surgery due to misdiagnosis.

Analysis of misdiagnosis and mistreatment of epidermoid cyst in intrapancreatic accessory spleen / 中华胰腺病杂志

Objective To investigate the imaging characteristics and the cause for the misdiagnosis and mistreatment of epidermoid cyst in intrapancreatic accessory spleen ( ECIPAS ) in order to improve the accuracy of preoperative diagnosis. Methods The clinical and imaging data of 8 patients with ECIPAS confirmed by pathology in Zhejiang Provincial People's Hospital between June 2008 and February 2018 were collected. The reason for doctor visit included CA19-9 elevation (n=1) and pancreatic occupying mass (n=9) during physical examination and no obvious symptoms were reported. CT and MRI imaging features, diagnosis and treatment were analyzed. Results The lesions in 8 cases of ECIPAS were all located in the tail of the pancreas and were cystic and solid. The lesions in 3 cases were mainly cystic and the cystic wall was linear, whose CT density, MRI signal and enhancement pattern cannot be compared with those of the spleen. Solid components can be seen in 5 cases, and the CT density or MR signal of the solid part was similar to that of the spleen. After enhancement, the solid part at the artery stage was uniformly enhanced and the enhancement degree was higher than that of the pancreas. Similar to the spleen, it was uniformly enhanced at the portal vein stage and the enhancement degree of the spleen was consistent. All 8 patients were diagnosed with pancreatic neoplastic lesions before surgery, and 1 patient had pancreatic fistula and peripancreatic necrosis after surgery. Postoperative pathology confirmed the diagnosis of ECIPAS. Conclusions Improving the radiologists and clinicians'cognition of the imaging manifestations of ECIPAS can improve the accuracy of preoperative diagnosis and avoid unnecessary surgery due to misdiagnosis.

The imaging features of epidermoid cyst within intrapancreatic accessory spleen / 中华放射学杂志

Objective To investigate the imaging features of epidermoid cyst within intrapancreatic accessory spleen (ECIPAS) to make benefits for differential diagnosis of pancreatic lesions. Methods We retrospectively reviewed the clinicalradiological and pathological data of 7 patients with pathologically confirmed ECIPAS. All the cases underwent plain and contrast enhanced CT scan, 2 cases underwent magnetic resonance cholangiopancreatography (MRCP), and 5 cases underwent ultrasonic examination. The imaging features of the lesions were analyzed. Results CT showed that 5 lesions were situated in the pancreatic tail while the other two located in the neck.The mean size of the lesions was (2.8± 1.2) cm,ranging from 1.5 to 4.8 cm. The cysts appeared multiocular in 2 cases. On plain CT, 2 cases showed well?defined low density foci, while 2 cases showed slightly high density. Calcification can be found in 2 cases. In 4 cases, the solid component surrounding the cyst displayed progressive enhancement on postcontrast CT. The enhancement was higher than the pancreatic parenchymaand similar to the spleen during both arterial and portal venous phases. On MRCP,no expansion was shown in pancreatic duct andit had no relationship with cyst in both 2 cases while slightly hypointensity could be found at the back and it pancreatic neck and body in 1 case. Five lesions were hypoechoic or anechoic and irregular?shaped on ultrasound. Conclusion ECIPAS is a rare benign lesion and the typical imaging manifestation is a cyst with surrounding solid component with enhancement similar to the spleen while higher than pancreas.

Morphological Variations Of Spleen: A Cadaveric Study In South Indian Population

Background and aim: Spleen, a secondary lymphoid organ presents with wide variations in morphology. Size andweight of the spleen varies at different ages and different individuals and in the same individuals under differentconditions. Further, a good knowledge about the morphological variations is very important to the physiciansand surgeons for any pathological conditions of spleen. The aim of the present study was to find out themorphological variations of spleens particularly in the South Indian Population.Materials and methods: A properly embalmed 40 cadaveric spleens were selected for the present study. The studywas carried out in the Department of Anatomy, Rajah Muthiah Medical College,Annamalai University,AnnamalaiNagar, Chidambaram, Cuddalore district, TamilNadu. The data were collected and statistical analysis was done.Results: The present study observed many variations in shapes and sizes of the spleen.Conclusions: In healthy states the spleen is not palpable. However, enlargement of spleen (splenomegaly) thatoccurs in malaria, kalaazar, sarcoidosis and leukaemia it becomes palpable. The morphological variations ofspleen in the present study will be useful to the physicians and surgeons in the diagnosis and treatment ofvarious disorders of spleen.

Accessory Spleen and Its Clinical Significance.

Spleen can have a wide range of anomalies in its shape, location, number and size. They can be congenital and acquired. Accessory spleen is a common congenital anomaly which is usually asymptomatic but might present clinically as an abdominal mass related to complications such as torsion, spontaneous rupture, haemorrhage and cyst formation Knowledge of splenic variations and anomalies is important to avoid diagnostic pitfalls and misinterpretations.

Morphological And Morphometric Study of Human Foetal Spleen.

Background: Spleen is a part of circulatory system, it is generally described with the lymphatic organs because of very large population of lymphocytes present in it. In surgical and medical history spleen has been described as a mysterious organ. Clear understanding and appreciation of its function emerged only later half of the 20th century, because of erythropoitic nature of foetal spleen the present study was conducted. Aims and Objects: To study variations on morphology and morphometry of human foetal spleen at different gestational ages. Materials and Methods: Foetal spleens were collected from SV Medical college, Tirupati and JJM Medical College, Davangere, India. Total 108 spleens were collected from foetal cadavers. The measurements length, width, thickness and weight of foetal spleen and ratio between foetal weight and spleen weight were measured. Results: The average length, width and thickness of foetal spleen of gestational age between 12 to 24 weeks were 1.7cm, 1.08 and 0.8cm respectively, gestational age between 25 to 36 weeks were 2.53cm, 1.64 and 1.0cm respectively and gestational age greater than 36 weeks were 2.67cm, 1.67 and 1.0cm respectively. The average foetal weight and spleen weight of gestational age between 12 to 24 weeks were 800gm and 2.84gm respectively and ratio between two was 0.35%, gestational age between 25 to 36 weeks were 1321.42gm and 4.52gm respectively ratio between two was 0.34% and gestational age greater than 36 weeks were 2100gm and 7.07gm respectively ratio between two was 0.33%. Conclusion: The measurements of foetal spleen are very helpful in medicine and surgical practice because of its clinical importance. The human foetal spleen is a secondary site of red blood cell.

Torsion of an Accessory Spleen; Diagnosed Preoperatively and Excised Laparoscopically

We report on a case of torsion of an accessory spleen occurring in a 19-year-old female. She was admitted with a three-day history of left-upper quadrant pain that became slowly aggravated. On physical examination, left-side abdominal tenderness was observed, most markedly in the left upper quadrant, but no rebound tenderness was noted. Contrast-enhanced computed tomography (CT) scan showed a non-enhancing mass with a tubular vascular pedicle and normal enhancing spleen in the left upper abdomen. Doppler ultrasound showed no vascular flow within the hypoechoic mass in the left upper abdomen. Torsion of an accessory spleen was suspected, and emergent laparoscopic exploration was performed. Laparoscopic exploration showed a large rounded violet mass with a tw isted vascular pedicle, located anterior to the normal spleen. The mass was excised laparoscopically and then removed through a 2.5 cm extended incision of the left-sided trocar incision. Postoperative recovery was normal and she was discharged on the fifth postoperative day.

Torsion of an Accessory Spleen; Diagnosed Preoperatively and Excised Laparoscopically

We report on a case of torsion of an accessory spleen occurring in a 19-year-old female. She was admitted with a three-day history of left-upper quadrant pain that became slowly aggravated. On physical examination, left-side abdominal tenderness was observed, most markedly in the left upper quadrant, but no rebound tenderness was noted. Contrast-enhanced computed tomography (CT) scan showed a non-enhancing mass with a tubular vascular pedicle and normal enhancing spleen in the left upper abdomen. Doppler ultrasound showed no vascular flow within the hypoechoic mass in the left upper abdomen. Torsion of an accessory spleen was suspected, and emergent laparoscopic exploration was performed. Laparoscopic exploration showed a large rounded violet mass with a tw isted vascular pedicle, located anterior to the normal spleen. The mass was excised laparoscopically and then removed through a 2.5 cm extended incision of the left-sided trocar incision. Postoperative recovery was normal and she was discharged on the fifth postoperative day.

Two Cases of Epidermoid Cysts in the Intrapancreatic Accessory Spleen Mimicking Pancreatic Cystic Neoplasm / 대한췌담도학회지

Epidermoid cyst in the intrapancreatic accessory spleen is extremely rare condition which could be mistaken for pancreatic cystic neoplasm. We report two cases of epidermoid cysts of intrapancreatic accessory spleen which mimicking pancreatic cystic neoplasm. Two patients, both male, aged 47 and 53 respectively were referred to our department for pancreatic mass. One was asymptomatic, whereas the other presented worsening abdominal pain and progressive weight loss. In both cases, the mass with cystic component was detected in the pancreatic tail in a computed tomography scan. Under a suspicion of pancreatic cystic neuronendocrine tumor, they underwent a distal pancreatectomy. Pathologic feature of resected specimens were shown to benign squamous lined cyst with splenic tissue in and around cyst wall which suggested that epidermoid cysts in the accessory spleen. We should take into account the possibility of epidermoid cyst in the intrapancreatic accessory spleen in the differential diagnosis of pancreatic cystic lesion.

Multidetector computed tomography characteristics of intra-pancreatic accessory spleen / 中华胰腺病杂志

Objective To summarize the imaging features of intra-pancreatic accessory spleen (IPAS)with multidetector computed tomography (MDCT) and improve the awareness and correct diagnosis of IPAS.Methods MDCT images of seven consecutive patients with surgically and pathologically confirmed IPAS were reviewed retrospectively.The investigated features included the location,size,shape,margin,density,and enhancement of the lesions.Results Four patients were male and three were female with a mean age of 49 years old.All the lesions were located at the dorsal side of parenchyma under the capsule of pancreatic tail.Three lesions were in round-like shape,and 4 in oval shape and all were well-defined.All the lesions were mass-like without necrosis and calcification.The maximum diameter of lesion ranged from 0.9 ～ 1.8 cm with a mean value of 1.4 cm.Compared with pancreatic parenchyma,the density of lesions were homogeneous on unenhanced CT,in arterial phase,slightly increased heterogeneous density was observed in 3 patients,slightly increased homogeneous density was observed in 4 patients.All the lesions appeared as slightly increased homogeneous density in portal phase.The CT value in unenhanced phase ranged from 50 ～ 61 Hu with a mean number of 55 Hu; and it ranged from 80 ～ 110 Hu with a mean number of 97 Hu in arterial phase; and the corresponding value was from 99 ～ 120 Hu with a mean number of 102 Hu in portal phase.Among the three patients underwent MDCT angiography,neither artery nor vein was compressed or invaded,and there was no vessel connected with lesions.Conclusions IPAS has some MDCT characteristics.For small solid mass in pancreatic tail,if the density and enhancement pattern is similar to that of spleen,the diagnosis of IPAS should be considered.

Subepithelial Lesion of the Gastric Fundus Caused by an Accessory Spleen / 대한내과학회지

When a submucosal lesion is discovered at the gastric fundus by gastroscopy, it may be difficult to distinguish a gastric external compression from a true submucosal tumor (SMT). The stomach is a hollow organ centrally placed in the upper abdomen, and it is possible to have a protruding external compression at the fundus, particularly from an enlarged spleen or splenic artery. An accessory spleen or splenosis is not a very unusual finding but may rarely produce such external compression at the gastric fundus. We experienced a case of an accessory spleen mimicking a gastric SMT diagnosed through a gastroscopy after a splenectomy.

Subepithelial Lesion of the Gastric Fundus Caused by an Accessory Spleen / 대한내과학회지

When a submucosal lesion is discovered at the gastric fundus by gastroscopy, it may be difficult to distinguish a gastric external compression from a true submucosal tumor (SMT). The stomach is a hollow organ centrally placed in the upper abdomen, and it is possible to have a protruding external compression at the fundus, particularly from an enlarged spleen or splenic artery. An accessory spleen or splenosis is not a very unusual finding but may rarely produce such external compression at the gastric fundus. We experienced a case of an accessory spleen mimicking a gastric SMT diagnosed through a gastroscopy after a splenectomy.

A Case of Intrapancreatic Accessory Spleen Mistaken as a Pancreatic Mass due to Different Enhancing Pattern from Normal Spleen / 대한소화기학회지

Most cases of accessory spleen show similar features as normal spleen in imaging studies. However, some accessory spleen has unusual scan feature which can be misdiagnosed. We present a case of intrapancreatic accessory spleen that was discovered incidentally during a workup for abdominal pain in a 47-year-old woman. CT and MRI revealed a different enhancing pattern from that of the spleen. Further evaluation with endoscopic ultrasonography failed to identify the pancreatic mass. Therefore, it was surgically removed and diagnosed pathologically as an accessory spleen.

Instructive value of preoperative splenic artery CTA examination in laparoscopic splenectomy / 中国综合临床

Objective To explore the instructive value of preoperative splenic artery CTA examination on Laparoscopic splenectomy (LS). Methods From January 2008 to February 2010,36 cases requiring Laparoscopic splenectomy (LS) were selected randomly and divided into two groups: CTA group and non-CTA group, 18 cases in each group. As for the CTA group,splenic artery CTA examination was performed before operation,to understand splenic artery and its branches anatomy type and track and then individualized surgical treatment was developed. As for the non-CTA group,a routine surgical procedure was performed. The indices before and during the operation were recorded and compared through χ2 test The operating time and the amount of bleeding in the two groups were compared using t-test Results There were no significant difference between the indices recorded by splenic artery CTA examination and those by laparoscopic splenectomy intraoperation ( P > 0. 05 ) . The operating time was (124. 32 ±21.43) mins in the CTA group, which was significantly shorter than that in the non-CTA group ((148.27 ±28. 36)mins) (P <0. 05). The amount of blood in the CTA group was significantly less than that in the non-CTA group( ( 80. 50 ± 16. 42) ml vs. (101. 35 ± 26.25 ) ml). Conclusions Splenic artery CTA can identify splenic artery and its branches anatomy type and track before LS,therefore guide the development of individualized surgical treatment It increases the safety of LS, reduces bleeding and shortens the operational time. It has an instrutive value to laparoscopic splenectomy.

A case of accessory splenic tuberculosis mimicking a distal pancreatic tumor / 대한내과학회지

Abdominal tuberculosis usually affects the gastrointestinal tract, peritoneum, lymph nodes, liver or spleen. Tuberculosis of the spleen is uncommon, except when associated with miliary dissemination. We report a case of a 33-year-old man with tuberculosis of the accessory spleen, which was originally suspected to be a distal pancreatic tumor. He was admitted with a history of left upper quadrant abdominal pain for 3 months. Computed tomography imaging of the abdomen revealed a 4.5 cm sized poorly defined hypodense mass in the distal pancreas and showed multiple focal hypodense lesions in the enlarged spleen. We performed distal pancreatectomy and splenectomy under the preoperative expectation of a distal pancreatic tumor. Microscopic examination of the specimens revealed accessory splenic tuberculosis associated with splenic tuberculosis. Following this, he was treated with appropriate antituberculosis drugs and was discharged without any complications.