AlSahli Alaa M, AlGhamdi Raed, AlAbeidi Fahad
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2022 May;94:107018. doi: 10.1016/j.ijscr.2022.107018. Epub 2022 Apr 2.
The term splenosis refers to autotransplantation of splenic tissue in ectopic sites. Ectopic splenic tissue may be found in the liver, thorax, pelvis and subcutaneous tissues following traumatic splenectomy. Although clinically insignificant, local symptoms such as abdominal pain may arise. In this paper we report a case of subcutaneous splenosis presenting 37 years post-traumatic splenectomy.
A 40-year-old medically free lady presented to our institution with a surgical history of post-traumatic splenectomy at the age of three and two cesarean sections. She complained for nonpainful right upper quadrant soft mass that has been stable in size over the years. Her laboratory results, including peripheral blood smear, were all within normal limits and no asplenic changes were detected. SPECT scan confirmed extraperitoneal splenosis in right upper quadrant.
Splenosis is an acquired form of ectopic splenic tissue that is defined as an auto-transplantation of a viable splenic tissue. It commonly occurs after traumatic rupture of the spleen.5 Splenosis has been widely reported around the world with an incidence of 16-67% after traumatic splenic rupture or splenectomy. Subcutaneous splenosis is an extremely rare condition, mostly observed in abdominal surgical scars. It is believed to follow laparotomy for splenectomy where splenic cells auto-implant or spread hematogenously at different locations.
Subcutaneous splenosis is a rare consequence of post-traumatic splenectomy that can manifest itself up to three decades after. Although concerning to the patient and alarming to the surgeon as it may resemble more serious entities such as abdominal wall sarcoma, surgical removal of asymptomatic splenosis is subject to the location of mass and patients' wishes.
脾组织异位种植是指脾组织在异位部位的自体移植。外伤性脾切除术后，可在肝脏、胸部、骨盆及皮下组织发现异位脾组织。尽管在临床上无显著意义，但可能会出现腹痛等局部症状。本文报告一例外伤性脾切除术后37年出现的皮下脾组织异位种植病例。
一名40岁健康女性因三岁时外伤性脾切除术及两次剖宫产手术史就诊于我院。她主诉右上腹有一无痛性软性肿块，多年来大小稳定。其实验室检查结果，包括外周血涂片，均在正常范围内，未检测到无脾改变。单光子发射计算机断层扫描（SPECT）证实右上腹有腹膜外脾组织异位种植。
脾组织异位种植是一种获得性异位脾组织形式，定义为存活脾组织的自体移植。它通常发生在脾脏外伤性破裂后。脾组织异位种植在世界各地均有广泛报道，外伤性脾破裂或脾切除术后的发生率为16% - 67%。皮下脾组织异位种植是一种极其罕见的情况，多见于腹部手术瘢痕处。据信，它是在脾切除术后剖腹手术时发生的，脾细胞在不同部位自体植入或经血行播散。
皮下脾组织异位种植是外伤性脾切除术后罕见的后果，可在术后长达三十年出现。尽管这会让患者担忧，也会让外科医生警觉，因为它可能类似于更严重的疾病，如腹壁肉瘤，但对于无症状的脾组织异位种植，是否进行手术切除取决于肿块的位置和患者的意愿。
