Laparoscopic Management of Pelvic Splenosis

Abstract

Abstract

Background: Splenosis refers to acquired auto transplantation of viable splenic tissue in a heterotopic location, and it usually follows traumatic splenic rupture and splenectomy. Heterotopic spleen can be found within the abdominal and pelvic cavities, but patients have been described with intrathoracic, subcutaneous, intrahepatic, and intracranial lesions. In women, it can mimic endometriosis and should also be distinguished from benign or malignant tumors. Case: A 45-year-old multiparous woman who had a splenectomy in childhood after trauma presented complaining of a long history of chronic pelvic pain and postcoital bleeding. Transvaginal ultrasonography (TVS) showed two pelvic masses, one measuring 21×16×17 mm and another measuring 31×13×32 mm, adjacent to the right ovary. Magnetic resonance imaging (MRI) revealed a possible fimbrial cyst measuring 2.2×2.7 cm near the right ovary and a tubular mass measuring 3.8×1.8 cm adjacent to the fimbrial cyst. The conclusion was possible tubal cancer. Tumor markers including cancer antigen 125 (CA-125) and carcinoembryonic antigen (CEA) were within normal limits. A laparoscopy revealed multiple splenic implants along the pelvic wall and peritoneal surface near the liver. Laparoscopic removal of the implants was successfully performed. The postoperative histological diagnosis confirmed splenic tissue. Conclusions: Splenosis must be considered in the differential diagnosis of previously splenectomized patients who present with unexplained masses and/or abdominal pain. Laparoscopic excision of the pelvic splenic implants dispelled all complaints in our case. (J GYNECOL SURG 29:13)