Successful endovascular treatment of a spontaneous bleeding accessory spleen: A case report

Abstract

Accessory spleens are often encountered in radiologic studies and they are not usually associated with symptoms. They could arise from autotransplantation of splenic tissue after splenic trauma or splenectomy (splenosis) [1]. In this case we describe a woman treated for splenectomy 20 years before and subsequently for adhesions, that suffered sudden left upper abdominal quadrant pain, weakness, and pale color. Contrast-enhanced computed tomography revealed free spilling in the abdomen and venous bleeding of a big accessory spleen; thus the patient underwent transcatheter arterial embolization with coils. Due to the 2 previous surgical operations in the splenic loggia, endovascular treatment compared to "open surgery" was the best choice in this case because of determined less complications, a shorter period of hospitalization, and a reduction of health cost.

Keywords: Accessory spleen; Bleeding; Embolization; Splenectomy.

Fig. 1

CECT Venous phase axial (A) and coronal (B) shows an accessory spleen (blue star) with a tenuous active bleeding inside (red circle) and perisplenic liquid fluid spill (green arrow). CECT, contrast-enhanced computed tomography. (Color version of figure is available online).

Fig. 2

(A and B) Selective DSA of the splenic artery shows 2 hypertrophic artery branches (blue arrows) arising from the residual portion of the splenic artery (black arrow) and feeding the accessory spleen hilus (red star). (C) Selective DSA of residual splenic artery after embolization demonstrates microcoils (green arrows) at hilus with no further opacification of the accessory spleen. DSA, digital subtraction angiography. (Color version of figure is available online).

Fig. 3

CECT 2 days after embolization demonstrates spleen devascularization (blue star) and reduction of fluid spill (green arrow). CECT, contrast-enhanced computed tomography. (Color version of figure is available online).

Fig. 4

(A) US 1 month later shows inhomogeneous ipoechoic accessory spleen (green arrow); (B) no blood sign at color-Doppler. (Color version of figure is available online).