Symptomatic pelvic accessory spleen

Accessory spleens are found most commonly at the splenic hilum, however, they rarely are symptomatic. An 18-year-old man presented with lower abdominal pain. Cross-sectional imaging studies with 3-dimensional reconstruction suggested the presence of a mass that was associated with the spleen. A nuclear medicine radioisotope scan confirmed that the mass was a pelvic accessory spleen. Laparoscopic excision was performed with excellent results. This accessory spleen was unusual in its size and location. Accessory spleens should be removed if symptomatic or if they are identified at splenectomy for hematologic disease.     

Infectious mononucleosis and splenic pseudocyst: presentation of a case

The authors report the clinical case of an 18-year-old patient who presented with a symptomatic mass in the left upper quadrant 6 months after having infectious mononucleosis. The preoperative investigation consisted principally of echography and computerized axial tomography of the abdomen, which demonstrated a cystic mass of the lower pole of the spleen. Splenectomy was carried out. Histologic examination showed a pseudocyst of the spleen with a fibrous capsule without an epithelial lining. The treatment and pathogenesis of pseudocysts of the spleen secondary to infectious mononucleosis are discussed.     

Laparoscopic fenestration and omentopexy as treatment for large splenic pseudocyst: Case report

Introduction and importancePseudocysts of the spleen are rare entities with cystic lesions of the spleen being uncommon in general. It is estimated that splenic cysts occur in about 0, 07% of the population¹. In general, splenic cystic lesions are discovered incidentally or by mass effect. In the literature, only a limited number of splenic cysts are reported. We report a case of splenic pseudocyst with mass effect where we used laparoscopic fenestration of the pseudocyst with omentopexy as a treatment of choice.Case presentationThe patient is a 62-year-old male with no previous history of trauma. He visited his GP for abdominal pain with flaring towards the left shoulder accompanied by early satiety, occasional obstipation, and breathing difficulties. He was referred to our hospital after enhanced computed tomography showed a 15 × 13 cm splenic cyst with displaced stomach and pancreatic tail medially and left kidney downward.Management options were discussed with the patient and he opted for a laparoscopic approach.In this case, we performed laparoscopic fenestration of the pseudocyst with omentopexy.Clinical discussionUntil recently splenectomy was the surgical treatment of choice for all large or symptomatic cystic lesions of the spleen^2, however with growing knowledge about the protective role of the spleen an approach with spleen protection is advocated.ConclusionThere are many advantages to the laparoscopic approach of splenic cystic lesions and it may be the treatment of choice for this uncommon surgical problem.     

The clinical spectrum of lymphangiomas and lymphangiomatosis of the spleen.

Lymphangiomas of the spleen are infrequent neoplasms of the spleen with clinical manifestations ranging from insignificant incidental findings to large, symptomatic cystic masses requiring surgical intervention. An associated syndrome may be lymphangiomatosis, in which the lymphangiomatous process involves other sites or organs, such as the liver, spleen, axilla, and mediastinum. Vasoformative neoplasms (hemangioma, lymphangioma) are relatively uncommon tumors or hamartomas of the spleen. Although well reported in the literature, their surgical significance is not well recognized. These lesions present a broad spectrum of pathologic findings of varied surgical importance. As incidental findings, they may be mistakenly considered as a valid indication for splenectomy. On the contrary, more extensive involvement of the spleen may cause symptomatic splenomegaly, which is a valid indication for splenectomy. When the spleen is diffusely involved (lymphangiomatosis), it may be part of a syndrome of generalized lymphangiomatosis involving structures and organs other than the spleen. This syndrome should be considered in obscure cases of splenomegaly in which the usual hematologic causes have been ruled out.     

Laparoscopic management of a ruptured giant epidermoid splenic cyst.

BACKGROUND: Epidermoid splenic cysts are uncommon lesions of the spleen. They are known to become symptomatic as a consequence of enlargement, infection, or rupture, the latter being an exceedingly rare complication traditionally treated with open splenectomy. We herein report a unique case of a giant epidermoid splenic cyst that ruptured spontaneously and was successfully treated with the laparoscopic approach. CONCLUSION: Laparoscopic surgery may be considered an initial treatment option in cases of very large epidermoid cysts even when rupture occurs.     

Laparoscopic management of non-parasitic splenic cysts

Non-parasitic cysts are an infrequent disease of the spleen. Most likely congenital in their origin, epithelial splenic cysts require surgical treatment if enlarged or symptomatic. The aim of this study was to assess the impact of the laparoscopic technique in the management of splenomegaly due to cystic disease. From July 2001 to September 2002 4 patients underwent laparoscopic splenectomy in our department for symptomatic enlarged non-parasitic splenic cysts. Cystic lesions were evaluated by ultrasonography, CT scan and magnetic resonance of the abdomen. The choice of total laparoscopic splenectomy according to the "hanged spleen" procedure was conditioned by the technical difficulty of performing conservative treatment due to the site of the upper pole of the enlarged lesions, adherent to the diaphragm in 3 cases, and by the presence of multiple trabeculated splenic cysts in 1 case. Laparoscopy was always completed and all patients obtained relief of their symptoms. When conservative treatment such as partial splenectomy or decapsulation may jeopardize the good outcome of the operation, the management of nonparasitic splenic cysts can be successfully achieved by total laparoscopic splenectomy.     

Spontaneous rupture of a wandering spleen: case report and literature review

Wandering spleen is a rare clinical entity. The etiology is not precisely known, and the management is controversial. Patients may become symptomatic when torsion of the pedicle results in pain, ischemia, infarction, or rupture. We present a spontaneous rupture of a wandering spleen without any history of trauma.     

Multiloculated peritoneal inclusion cysts with splenic involvement: a case report.

Multilocular peritoneal inclusion cysts (MPICs) are most commonly found in women of reproductive years and involve the abdomen, pelvis, and retroperitoneum. It is commonly thought that these cysts are due to an inflammatory reaction. Patients usually present with chronic abdominal or pelvic pain and are diagnosed by ultrasound or CT scan. Although there are experimental medical treatment options surgical excision remains the current recommended primary therapy for symptomatic disease. The following case describes a pregnant female with rare MPIC involving the spleen and peritoneum. Biological behavior of MPIC and current therapy options are also discussed.     

Conservative treatment of splenic lesions by splenorrhaphy and incomplete splenectomy in abdominal injuries

Fifteen cases of rupture of the spleen were reported, in which a conservative form of treatment was applied with success. These consisted of 4 splenorrhaphies and 11 partial splenectomies. Collagen (PANGEN) was used in 6 of the cases to buttress the suture. In view of the relatively low incidence of post of complications, the authors are of the opinion that the above described treatment be widely applied in cases of rupture of the spleen, especially in the child where the spleen still plays a vital role.     

Splenosis after splenic rupture: a disease to be recognized]

One case of peritoneal splenosis is reported. The diagnosis was established at surgery in a 17-year-old female patient presenting with dull abdominopelvic pain, who had undergone total splenectomy after a trauma ten years earlier. This autograft of splenic tissue must be known to be acknowledged, especially today, when the conservative treatment advocated for ruptures of the spleen may increase its incidence. The literature reports only about one hundred cases. The treatment only consists in removing the sole symptomatic nodules.     

Wandering spleen with chronic torsion

Wandering spleen, a rare clinical entity with a high incidence of splenic torsion and infarction, was preoperatively diagnosed in a 28-year-old woman. Axial computed tomography showed the absence of the spleen in the left subphrenic space and a spleen-like mass in the pelvis, suggestive of a wandering spleen. A coronal contrast-enhanced computed tomography image exhibited the enlarged spleen suspended by elongated, dilated, and somewhat tortuous splenic vessels. Owing to the symptomatic splenomegaly with hypersplenism and chronic torsion, laparoscopic splenectomy was performed.     

Early experience of intra-ureteric capsaicin infusion in loin pain haematuria syndrome

OBJECTIVES: To evaluate early results of the intra-ureteric instillation of capsaicin for the treatment of loin pain haematuria syndrome (LPHS). PATIENTS AND METHODS: Ten patients with LPHS were treated using intra-ureteric capsaicin instillation. A solution of capsaicin was infused into the affected ureter through an embolectomy catheter, under anaesthesia. The success of the treatment was assessed using patient questionnaires and the quantitative reduction in the patients' analgesic requirements measured. RESULTS: During a mean follow-up of 6 months, six of the 10 patients had short- to medium-term symptomatic relief after one or more treatments; four had no relief from their symptoms. One patient had a mucosal ulceration in the bladder after extravasation of the capsaicin solution. Two patients subsequently underwent simple nephrectomy for symptomatic nonfunctioning kidneys. CONCLUSION: These results are consistent with other preliminary reports of the efficacy of capsaicin treatment in LPHS and such treatment therefore has a definite therapeutic role in this difficult condition. We are uncertain if the treatment contributed to the deterioration of the excised kidneys. This early experience suggests a need for careful consideration when contemplating this treatment, with attention directed to both the initial diagnosis and possibly the technique of capsaicin/instillation. We include a protocol to follow when preparing patients for capsaicin treatment.     

Posttraumatic Splenic Cysts and Partial Splenectomy: Report of a Case

Nonparasitic splenic cysts are uncommon, with only around 800 cases described in the literature. Posttraumatic splenic pseudocysts constitute most such cases and require surgical treatment when symptomatic or voluminous. Recent studies have provided a better understanding of splenic tissue function and the consequent risks of complete resection of the spleen. Hence surgeons should make every possible effort to preserve splenic tissue. Several spleen-conserving surgical treatments have been proposed, especially for treatment of splenic posttraumatic pseudocysts. The authors report the case of a 13-year-old girl who had a posttraumatic splenic cyst with progressive growth. The diameter of the cyst at surgery was 15 cm, and partial splenectomy was performed. The most common spleen-conserving surgical techniques are briefly reviewed. Received: September 20, 1999 / Accepted: September 26, 2000     

Peritoneal carcinomatosis-like implants of extramedullary hematopoiesis. An insolite occurrence during splenectomy for myelofibrosis

IntroductionPrimary myelofibrosis (MF) is a myeloproliferative neoplasm that results in debilitating constitutional symptoms, splenomegaly, and cytopenias. In patients with symptomatic splenomegaly, splenectomy remains a viable treatment option for MF patients with medically refractory symptomatic splenomegaly that precludes the use of ruxolitinib.Case presentationWe present the clinical case of a patient who was admitted to our Department to perform a splenectomy in MF as a therapeutic step prior to an allogeneic stem cell transplantation (ASCT). A laparotomic splenectomy and excision of whitish wide-spread peritoneal and omental nodulations was performed. There were no operative complications and the surgery was completed with minimal blood loss. The histopathological exam revealed an extramedullary hematopoiesis in both spleen and peritoneal nodules.ConclusionIn primary myelofibrosis it must always be kept in mind the possible presence of peritoneal implants of extramedullary hematopoiesis and ascites of reactive genesis. We report a rare case of peritoneal carcinomatosis-like implants of extramedullary hematopoiesis found at splenectomy for MF.     

Laparoscopic splenectomy for histiocytic sarcoma of the spleen

Primary histiocytic sarcoma of the spleen is a rare but potentially lethal condition. It can remain asymptomatic or only mildly symptomatic for a long time. An 81-year-old woman presented with an extremely enlarged spleen. She suffered from progressive anemia and required a red blood cell transfusion once a month. Although computed tomography, ultrasonography, and magnetic resonance imaging were performed for diagnosis, a confirmed diagnosis was not obtained. Her enlarged spleen compressed her stomach, and she suffered from gastritis and a sense of gastric fullness just after meals. She underwent laparoscopic splenectomy for therapeutic and diagnostic purposes. Her post-operative course was uneventful. After surgery, her red blood cell and platelet counts increased markedly. The tumor was diagnosed as splenic histiocytic sarcoma. Post-surgical chemotherapy was not performed, and the patient died of liver failure due to liver metastasis 5 mo after surgery. Laparoscopic splenectomy is minimally invasive and useful for the relief of symptoms related to hematological disorders. However, in cases of an enlarged spleen, optimal views and working space are limited. In such cases, splenic artery ligation can markedly reduce the size of the spleen, thus facilitating the procedure. The case reported herein suggests that laparoscopic splenectomy may be useful for the treatment of splenic malignancy.     

中医药从脾论治骨质疏松症

摘要：中医药防治骨质疏松症是医学领域研究的热点，临床从脾、肾论治多获良效，其机制研究也逐渐开展。脾虚是骨质疏松症发病的基础，益气健脾法以“资四肢形骸、丰肌肉筋骨”为旨，在缓解临床症状、改善骨密度、调节骨代谢平衡等方面具有显著作用。愈来愈多的基础研究表明，益气健脾法可通过调节内分泌、神经、运动、消化、循环等系统发挥抗骨质疏松作用。为进一步挖掘从脾论治骨质疏松症的临床价值与科学内涵，笔者从中医经典理论、临床研究与基础实验方面综述益气健脾法抗骨质疏松的疗效及可能机制，以期拓宽中医药防治骨质疏松症的研究思路。     

中医从脾论治原发性骨质疏松症的研究进展

骨质疏松症是一种以骨量低下,骨微结构损坏,导致骨脆性增加,易发生骨折为特征的全身性骨病。当前实验研究及临床观察对原发性骨质疏松症以肾虚为主要病机,补肾为主要治法形成普遍认识,而脾虚对本病的影响研究相对较少。根据中医学对骨质疏松症病因病机特点的认识,结合现代医学对中医药治疗骨质疏松症的研究,对骨质疏松症的防治要按照中医的理法方药进行辩证论治,因证施治,不能简单地治疗某一脏一腑,要看到骨质疏松症的复杂性和难治性。从传统医学中脾对骨质疏松症的认识到脾脏与骨质疏松症关系的实验研究再到健脾补肾的临床观察,无不表明脾虚在原发性骨质疏松症的重要地位。肾虚为骨质疏松症的主要病机,补肾滋肾的治疗总则固然重要,与此同时必须要重视补益脾胃。     

Giant epidermoid cyst of the spleen with carbohydrate and cancer antigen production managed laparoscopically

True cysts of the spleen are rare; in a few cases, high serum levels of carbohydrate and cancer antigen have been reported. In such instances, cyst resection or splenectomy is indicated to rule out malignant lesions and to remove the cancer antigen producing epithelium. We report the case of a young woman with a symptomatic giant epidermoid cyst of the spleen. Due to the secreting epithelium lining the cyst, serum levels of CA 19-9 and CA 125 were elevated. Laparoscopic splenectomy achieved symptoms relief and and long-term normalization of serum tumor markers.     

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目的 探讨区域性门静脉高压症的诊断和治疗。方法 回顾总结5年收治的8例区域性门静脉高压症，分析病因、诊断和治疗方式。结果 主要病因：胰体尾肿瘤和假性囊肿（各2例）、后腹膜淋巴结结核（3例）和脾脏结核（1例）。术前明确诊断3例，手术6例，随访观察2例。结论 诊断关键在于提高对区域性门静脉高压症的认识。对有症状的区域性门静脉高压症宜行手术治疗，对无症状的可予随访观察。     

脾肾-肌骨-线粒体理论探析

黄宏兴教授课题组长期致力于研究骨质疏松症的中医药防治，首次提出脾肾-肌骨-线粒体理论，历年来的相关研究使得该理论逐步完善。本文通过整理相关资料，明确脾肾、肌骨、线粒体三者关系，精炼出该理论的核心内容：骨质疏松与脾肾、线粒体、肌骨关系密切；脾肾-肌骨-线粒体理论基本内容包含了脾肾共司肌骨、线粒体功能与脾肾相通两个核心内容。脾肾-肌骨-线粒体理论是结合中医学中的“脾肾相关”“脾主肌肉”“肾主骨”和现代生物学中的线粒体功能发展而来，其充分运用中医辨证施治原则，在防治骨质疏松症实际应用中发挥着重要作用。本文通过介绍该理论的演变、发展沿革及应用，为骨质疏松症的防治提供实验研究和临床应用相关材料。