- Email: [email protected]
Document not found! Please try again
Conservative management of pelvic spleen
International Journal of Gynecology & Obstetrics 46 (1994) 65-66
Letter to the editor
Conservative management of pelvic spleen A.M. Khalil*, G.B. Azar, K.S. Karam Department
of Obstetrics and Gynecology,
American University of Beirut Medical Center, Beirut, Lebanon
Received 7 January 1994; revision received 28 February 1994; accepted 28 February 1994
Keywork
Ectopic
spleen; Adnexal
mass
Adnexal tumors tend to originate from the female genital tract [l]. However, a rare occurrence of an adnexal mass can be due to a pelvic spleen. Surgical removal is recommended to avoid torsion and rupture [2,3]. We report a case of a pelvic spleen that was left in situ with no complications over a 15-year period. Our patient was a 21-year-old nulliparous female who was noted to have an asymptomatic left adnexal mass on routine examination. Pelvic ultrasound confirmed the presence of a 9 x 9 cm solid mass in the left adnexal region. She had been maintained on oral contraceptive pills for 6 months. At laparotomy, the uterus, ovaries and tubes were normal. A large red mass located posterior to the uterus was attached to a long pedicle originating from the left upper quadrant of the abdomen. Palpation of the other abdominal organs was normal. The diagnosis of ectopic pelvic spleen was made. It was not resected, however, as
* Corresponding author, Department of Obstetrics and Gynecology, American University of Beirut, 850, 3rd Avenue, New York, NY 10022, USA.
the family did not give their consent. Five years later, she had an uncomplicated term vaginal delivery. The patient has remained completely asymptomatic for the past 15 years. An accessory spleen occurs in 10% of the general population with females being more frequently affected [ 11.However, a pelvic spleen presenting as an adnexal mass is a rare occurrence. Splenic descent is attributed to the flexibility of the gastrosplenic and phrenicosplenic ligaments [ 11. Patients with a pelvic spleen are usually asymptomatic; they rarely present with pressure symptoms such as pelvic heaviness, urinary frequency and tenesmus [l]. Usually it is unexpected intraoperative finding. Excision of wandering spleen is advocated to avoid potentially lethal, although rare complications, such as torsion and rupture [2,3]. Moreover, an unexcised pelvic spleen may mask other pelvic diseases and makes early detection of a true ovarian neoplasm less likely. In our case, the pelvic spleen was not resected and the patient has been asymptomatic for 15 years. In the absence of pathognomonic clinical and sonographic features, preoperative diagnosis of pelvic spleen is unlikely. Despite its rarity, pelvic spleen
0020-7292/94/%07.00 0 1994 International Federation of Gynecology and Obstetrics SSDI 0020-7292(93)02083-B
66
Letters to the editor /Int. J. Gynecol. Obsret. 46 (1994) 65-66
should be considered in the differential diagnosis of adnexal tumors. In spite of the successful conservative approach in our case, surgical removal of pelvic spleen is strongly suggested to avoid serious complications.
References 111 Azar GB, Awwad JT, Mufarrij IK: Accessory spleen PI 131
presenting as an adnexal mass. Acta Obstet Gynecol Stand 72: 12, 1993. Simpson A, Ashby EC: Torsion of wandering spleen. Br J Surg 52: 344, 1965. Texeira MB, Hardin NJ: Spontaneous rupture of accessory spleen. Am Surg 40: 491, 1974.
Letter to the editor
Conservative management of pelvic spleen A.M. Khalil*, G.B. Azar, K.S. Karam Department
of Obstetrics and Gynecology,
American University of Beirut Medical Center, Beirut, Lebanon
Received 7 January 1994; revision received 28 February 1994; accepted 28 February 1994
Keywork
Ectopic
spleen; Adnexal
mass
Adnexal tumors tend to originate from the female genital tract [l]. However, a rare occurrence of an adnexal mass can be due to a pelvic spleen. Surgical removal is recommended to avoid torsion and rupture [2,3]. We report a case of a pelvic spleen that was left in situ with no complications over a 15-year period. Our patient was a 21-year-old nulliparous female who was noted to have an asymptomatic left adnexal mass on routine examination. Pelvic ultrasound confirmed the presence of a 9 x 9 cm solid mass in the left adnexal region. She had been maintained on oral contraceptive pills for 6 months. At laparotomy, the uterus, ovaries and tubes were normal. A large red mass located posterior to the uterus was attached to a long pedicle originating from the left upper quadrant of the abdomen. Palpation of the other abdominal organs was normal. The diagnosis of ectopic pelvic spleen was made. It was not resected, however, as
* Corresponding author, Department of Obstetrics and Gynecology, American University of Beirut, 850, 3rd Avenue, New York, NY 10022, USA.
the family did not give their consent. Five years later, she had an uncomplicated term vaginal delivery. The patient has remained completely asymptomatic for the past 15 years. An accessory spleen occurs in 10% of the general population with females being more frequently affected [ 11.However, a pelvic spleen presenting as an adnexal mass is a rare occurrence. Splenic descent is attributed to the flexibility of the gastrosplenic and phrenicosplenic ligaments [ 11. Patients with a pelvic spleen are usually asymptomatic; they rarely present with pressure symptoms such as pelvic heaviness, urinary frequency and tenesmus [l]. Usually it is unexpected intraoperative finding. Excision of wandering spleen is advocated to avoid potentially lethal, although rare complications, such as torsion and rupture [2,3]. Moreover, an unexcised pelvic spleen may mask other pelvic diseases and makes early detection of a true ovarian neoplasm less likely. In our case, the pelvic spleen was not resected and the patient has been asymptomatic for 15 years. In the absence of pathognomonic clinical and sonographic features, preoperative diagnosis of pelvic spleen is unlikely. Despite its rarity, pelvic spleen
0020-7292/94/%07.00 0 1994 International Federation of Gynecology and Obstetrics SSDI 0020-7292(93)02083-B
66
Letters to the editor /Int. J. Gynecol. Obsret. 46 (1994) 65-66
should be considered in the differential diagnosis of adnexal tumors. In spite of the successful conservative approach in our case, surgical removal of pelvic spleen is strongly suggested to avoid serious complications.
References 111 Azar GB, Awwad JT, Mufarrij IK: Accessory spleen PI 131
presenting as an adnexal mass. Acta Obstet Gynecol Stand 72: 12, 1993. Simpson A, Ashby EC: Torsion of wandering spleen. Br J Surg 52: 344, 1965. Texeira MB, Hardin NJ: Spontaneous rupture of accessory spleen. Am Surg 40: 491, 1974.