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Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary?

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Abstract

Background

Some one-fifth of patients may have accessory spleens (AcS) and require their removal at the time of splenectomy to achieve and maintain hematological response. The purpose of this study was to evaluate the benefit of computed tomography (CT) in patients undergoing laparoscopic splenectomy (LS).

Methods

All patients who required splenectomy were offered LS and underwent preoperative contrast-enhanced CT scan to detect and locate AcS. The surgeon was not blinded to the result of the CT scan. Patients were followed up to determine if there was recurrent disease.

Results

Between 2000 and 2007, 58 consecutive patients (31 men) were referred for splenectomy and all underwent LS. Preoperative CT scan detected 11 AcS in 11 patients (19%), of which 9 were confirmed during LS; the remaining 2 patients suffered with ITP preoperatively and had a good hematologic response to LS. At LS, 14 AcS were found in 13 patients (22%), of which 4 patients had negative preoperative CT scan; those additional AcS were readily found and were located close to the lower pole or hilum of the spleen. All removed AcS were confirmed histologically. In one patient who had LS and removal of AcS for ITP a further AcS within the tail of the pancreas was detected 1 year postoperatively on CT after thrombocytopenia relapsed. The sensitivity and specificity of CT scan for the detection of AcS were 60% and 95.6%, and the corresponding values for laparoscopy were 93.3% and 100%, respectively. Pairwise comparison of the ROC curves identified laparoscopy to be associated with a significantly higher area under the curve compared with CT scan (0.967 vs. 0.673; P = 0.004).

Conclusions

Accessory spleens can be readily detected at laparoscopy in the vicinity of the spleen; preoperative CT scan for their detection and localization may not be necessary.

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References

  1. Dodds WJ, Taylor AJ, Erickson SJ, Stewart ET, Lawson TL (1990) Radiologic imaging of splenic anomalies. Am J Radiology 155:805–810

    CAS  Google Scholar 

  2. Mortele KJ, Mortele B, Silverman SG (2004) CT features of the accessory spleen. Am J Roentgenol 183(6):1653–1657

    Google Scholar 

  3. Halpert B, Gyorkey F (1959) Lesions observed in accessory spleens of 311 patients. Am J Clin Pathol 32(2):165–168

    CAS  PubMed  Google Scholar 

  4. Beahrs JR, Stephens DH (1980) Enlarged accessory spleens: CT appearance in postsplenectomy patients. Am J Roentgenol 135(3):483–486

    CAS  Google Scholar 

  5. Targarona EEJ, Lomena F, Trias M (1999) Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. Surg Endosc 13:196–197

    Article  CAS  PubMed  Google Scholar 

  6. Taragona E, Espert JJ, Balague C, Sugranes G, Ayuso C, Lomeña F, Bosch F, Trias M (1998) Residual splenic function after laparoscopic splenectomy. Arch Surg 133:56–60

    Article  Google Scholar 

  7. Finkelde D, Kicks RJ, Wolf M, Henderson MA (2000) Handheld gama probe localization of accessory splenic tissue in recurrent idiopathic thrombocytopenic purpura. Surg Endosc 135:1112–1114

    CAS  Google Scholar 

  8. Facon T, Caulier MT, Fenaux P (1992) Accessory spleen in recurrent chronic immune thrombocytopenic purpura. Am J Hematol 41:184–189

    Article  CAS  PubMed  Google Scholar 

  9. Morris K, Horvath KD, Jobe BA, Swanstrom LL (1999) Laparoscopic management of accessory spleens in immune thrombocytopenic purpura. Surg Endosc 13:520–522

    Article  CAS  PubMed  Google Scholar 

  10. Rudowski W (1985) Accessory spleens: clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura. World J Surg 9:422–430

    Article  CAS  PubMed  Google Scholar 

  11. Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E (2008) Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 22(4):821–848

    Article  CAS  PubMed  Google Scholar 

  12. Napoli A, Catalano C, Silecchia G, Fabioano P, Fraioli F, Pediconi F, Venditti F, Basso N, Passariello R (2004) Laparoscopic splenectomy: multidetector row CT for preoperative evaluation. Radiology 232:361–367

    Article  PubMed  Google Scholar 

  13. Gigot J, Mabrut JY, Matairie S, Jamar F, Ferrant A, van Beers BE, Gianello P (2004) Failures following laparoscopic splenectomy and their management with special reference to accessory spleens and splenosis. Prob Gen Surg 19:80–94

    Article  Google Scholar 

  14. Stanek A, Stefaniak T, Makarewicz W, Kaska L, Podgorczyk H, Hellman A, Lanchinski A (2005) Accessory spleens: preoperative diagnostics limitations and operational strategy in laparoscopic approach to splenectomy in idiopathic thrombocytopenic purpura patients. Langenbecks Arch Surg 390:47–51

    Article  PubMed  Google Scholar 

  15. Barbaros U, Dinccag A, Erbil Y, Mercan S, Sanli Y, Adalet I, Kucukkaya R (2007) Handheld gamma probe used to detect accessory spleens during initial laparoscopic splenectomies. Surg Endosc 21:115–119

    Article  PubMed  Google Scholar 

  16. Wadham BM, Johnson MA (1981) Incidence and location of accessory spleens. New Engl J Med 304:1111

    CAS  PubMed  Google Scholar 

  17. Gigot J, Jamar F, Ferrant A, van Beers BE, Lengele B, Pauwels S, Pringot J et al (1997) Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. Surg Endosc 12:101–106

    Article  Google Scholar 

  18. Ambriz P, Munoz R, Quintanar E, Sigler L, Aviles A, Pizzuto J (1985) Accessory spleen compromising response to splenectomy for idiopathic thrombocytopenic purpura. Radiology 1:793–796

    Google Scholar 

  19. Gigot J, Lengele B, Gianello P, Etienne J, Claeys N (1998) Presence status of laparoscopic splenectomy for haematological disease: certitudes and unresolved issues. Semin Laparasc Surg 5:147–167

    CAS  Google Scholar 

  20. Velanovich V, Shurafa M (2000) Laparoscopic excision of accessory spleen. Am J Surg 180(1):62–64

    Article  CAS  PubMed  Google Scholar 

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Disclosures

All of the named authors, Conal Quah, Georgios D. Ayiomamitis, Asim Shah, and Basil J. Ammori, have no conflicts of interest or financial ties to disclose.

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Correspondence to Basil J. Ammori.

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Quah, C., Ayiomamitis, G.D., Shah, A. et al. Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary?. Surg Endosc 25, 261–265 (2011). https://doi.org/10.1007/s00464-010-1171-2

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  • DOI: https://doi.org/10.1007/s00464-010-1171-2

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