Spaziani Erasmo, Di Filippo Annalisa Romina, Valle Giampaolo, Francioni Piero, Fiorentino Francesco, Spaziani Martina, Vega Raffaella, Picchio Marcello, De Cesare Alessandro
Ann Ital Chir. 2022 Oct 5;11:S2239253X22037914.
Splenosis is a benign clinical condition caused by the heterotopic autotransplantation of spleen's tissue tipically occurring after spleen rupture. Splenosis may be asymptomatic and found accidentally. When signs and symptoms occur they are due to mass effect or bleeding of the splenic nodules.
74-years-old male presenting with intestinal sub-occlusion and past medical history of post-traumatic splenectomy at 18-years-old. Based on TC findings of multiple hyperenhanced solid lesions located in greater omentum, mesentery and parietal peritoneum of right pelvic walls, the presumptive diagnosis was peritoneal carcinomatosis of unknown primary site. Stenosis of a ileum loop in the right pelvis, with dilatation and faecal stasis of the upstream loops proximal, required surgical procedure. At the opening of the peritoneal cavity the multifocal lesions varied in size, were reddish blu color, sessile, lobulate and with strong adhesions to the visceral peritoneum. Omentectomy and the blunt exicision of 3 extraparietal solid nodules, which had tenacious adhesions with stenotic ileum loop serosa for the lenght of 8 cm, were performed. Histopathological examination of surgical specimens showed splenic tissue with red pulp.
CT scan usually do not allow to make a certain diagnosis of splenosis, so the clinical history of splenic trauma or splenectomy, positive in all cases reported in literature, represent the key in the diagnostic pathway of splenosis. Management should be conservative as much as possible nonetheless in abdominal splenosis the surgical approach should be chosen for the symptomatic patients who present abdominal pain, occlusion or bleeding.
Abdominal, Splenosis, Spleen, Surgery.
脾种植是一种良性临床病症，由脾脏组织异位自体移植引起，通常发生在脾破裂后。脾种植可能无症状，偶然发现。当出现体征和症状时，是由于脾结节的占位效应或出血所致。
一名74岁男性，出现肠梗阻，既往有18岁时创伤后脾切除术病史。根据CT检查发现多个高密度强化实性病变位于大网膜、肠系膜和右盆腔壁的腹膜壁层，初步诊断为原发部位不明的腹膜癌。右盆腔回肠袢狭窄，近端肠袢扩张并伴有粪便淤滞，需要进行手术。打开腹腔时，多灶性病变大小不一，呈红蓝色，无蒂，分叶状，与脏腹膜有紧密粘连。进行了大网膜切除术，并钝性切除了3个位于壁外的实性结节，这些结节与狭窄的回肠袢浆膜紧密粘连达8厘米。手术标本的组织病理学检查显示为含有红髓的脾组织。
CT扫描通常无法确诊脾种植，因此脾创伤或脾切除的临床病史（文献报道的所有病例均为阳性）是脾种植诊断途径的关键。治疗应尽可能保守，尽管如此，对于出现腹痛、梗阻或出血的有症状的腹部脾种植患者，应选择手术治疗。
腹部；脾种植；脾脏；手术
