Wacha M, Danis J, Wayand W
Second Surgical Department and Ludwig Boltzmann Institute for Surgical Laparoscopy at the General Hospital of Linz, Krankenhausstrasse 9, A-4020 Linz, Austria.
Surg Endosc. 2002 Aug;16(8):1242-3. doi: 10.1007/s00464-001-4241-7. Epub 2002 May 23.
During a diagnostic laparoscopy in a patient with chronic lower abdominal pain we found a pediculated accessory spleen (AS) near the left adnex. The pedicle was dissected by ultrascision, it was cut by an Endo GIA, and the AS was extracted. AS occurs in 25-40% of the population. They are always situated on the left side: hilum of the spleen, splenic artery, pancreas, splenocolic ligament, greater omentum, mesenterium, adnexal region, and scrotum. In most cases they are asymptomatic. In hematological disorders they can take over the function of the original spleen after splenectomy. Sometimes, AS can mimic tumors in other organs, such as pancreas, kidney, or liver. Likewise, there are descriptions of AS in the scrotum, the spermatic cord, the adnexes, the uterus, the stomach, the small intestine, or the heart. In rare cases they can cause pain because of cysts, abscesses, hemorrhage, or spontaneous rupture. In acute pedicle torsion an infarction can be caused presenting as acute abdomen, which is most often seen in young patients. In our case the pain was caused by pedicle torsions or mechanical irritation of the adnex. The cause of the changing localization of the pain was the long pedicle. In describing this case, we point out the advantage of diagnostic laparoscopy in patients with chronic lower abdominal pain.
在对一名慢性下腹痛患者进行诊断性腹腔镜检查时，我们在左附件附近发现了一个有蒂的副脾（AS）。用超声刀分离蒂部，用Endo GIA切断，然后取出副脾。副脾在25% - 40%的人群中存在。它们总是位于左侧：脾门、脾动脉、胰腺、脾结肠韧带、大网膜、肠系膜、附件区和阴囊。大多数情况下它们是无症状的。在血液系统疾病中，脾切除术后它们可以承担原脾的功能。有时，副脾可酷似其他器官的肿瘤，如胰腺、肾脏或肝脏。同样，也有关于阴囊、精索、附件、子宫、胃、小肠或心脏中副脾的描述。在罕见情况下，它们可因囊肿、脓肿、出血或自发性破裂而引起疼痛。在急性蒂扭转时可导致梗死，表现为急腹症，这在年轻患者中最常见。在我们的病例中，疼痛是由蒂扭转或附件的机械性刺激引起的。疼痛定位改变的原因是蒂较长。在描述这个病例时，我们指出了诊断性腹腔镜检查在慢性下腹痛患者中的优势。
