Adjoining spleen

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Classification according to ICD-10
Q89.0 Congenital malformations of the spleen
ICD-10 online (WHO version 2019)

A spleen ( Splen accessory , Lien accessory , Splenunculus ) is the result of a common embryological aberration in which one or more small nodules from spleen tissue regardless of the spleen , usually in the region of the hilum, in the abdominal cavity are present. This standard variant must be differentiated from splenosis , which is the result of splenic tissue splintering as part of a spleen injury.

Epidemiology

Adjacent spleens are found in 10–30% of cases in autopsy studies.

etiology

Ancillary spleens arise as a result of malformation during the embryonic period. The underlying causes are largely unknown. An increased occurrence of intrapancreatic secondary spleens and other developmental abnormalities of the spleen are described in trisomy 13 ( Patau syndrome ).

pathology

Adjacent spleen (14 mm) in the ultrasound image .

Macroscopically, minor spleens appear as roundish, usually about cherry-sized, 1–1.5 cm (maximum about 4 cm) measuring, usually limited by a thin capsule, masses of dark reddish color. They are predominantly located in the area of ​​the splenic hilum (75% of cases), but are also located along the splenic vessels, in the gastrosplenic or splenorenal ligaments, the walls of the stomach and intestines , in the tail of the pancreas , the mesentery and, rarely, in the pelvis or region Scrotums found. Few individual reports describe the presence of spleen tissue within the liver parenchyma. Adjunct spleens occur singly or multiple, although their number rarely exceeds six. In terms of tissue , the structure of an auxiliary spleen corresponds to that of the spleen, i.e. the foci are composed of a red and white pulp .

clinic

In most patients, the diagnosis of one or more accessory spleens is an asymptomatic incidental finding with no need for therapeutic intervention. As with splenosis, there is a fundamental risk that accessory spleens will be misinterpreted in diagnostic imaging as a tumor disease or lymph node swelling. After a spleen has been removed ( splenectomy ), for example for the treatment of hypersplenism (overfunction of the spleen with abnormally increased blood cell sequestration), secondary spleens can take over the function of the spleen in whole or in part and thus cancel the intended therapeutic effect. A rare acute complication associated with secondary spleens is an acute abdomen as a result of a secondary spleen infarction with or without torsion of the blood vessel supply.

Individual evidence

  1. ↑ a b c I. Varga, P. Galfiova, M. Adamkov, L. Danisovic, S. Polak, E. Kubikova, S. Galbavy: Congenital anomalies of the spleen from an embryological point of view. In: Med Sci Monit. 15 (12), Dec 2009, pp. RA269-RA276. PMID 19946246
  2. ↑ WJ Dodds, AJ Taylor, SJ Erickson: Radiologic imaging of splenic anomalies. In: Am J Radiol. 155, 1990, pp. 805-810.
  3. ↑ JL Freeman, SZH Jafri, JL Roberts et al: CT of congenital and acquired abnormalities of the spleen. In: RadioGraphics. 13, 1993, pp. 597-610. PMID 8316667
  4. ↑ K. Gomi, Y. Sato, M. Tanaka et al .: Specificity of splenopancreatic field anomaly in trisomy 13 syndrome: Macroscopic and histological analysis in 21 autopsy cases. In: Pathol Internat. 59, 2009, pp. 147-151. PMID 19261091
  5. ^ Keith L. Moore: Clinically Oriented Anatomy. 3. Edition. Williams & Wilkins, Baltimore 1992, ISBN 0-683-06133-X , p. 187.
  6. ↑ TL Babcock, DD Coker, JL Haynes, HB Conklin: Infarction of an accessory spleen causing an acute abdomen. In: The American Journal of Surgery . 127, 1974, pp. 336-337. PMID 4812242
  7. ↑ P. Impellizzeri, AS Montalto, FA Borruto, P. Antonuccio, G. Scalfari, F. Arena, C. Romeo: Accessory spleen torsion: rare cause of acute abdomen in children and review of literature. In: J Pediatr Surg. 44 (9), Sep 2009, pp. E15 – e18. PMID 19735802