Introduction: Accessory spleen is an abnormality represented by ectopic splenic tissue detached from the main body of the spleen. Torsion is a possible complication and it occurs exceptionally. Clinically it is characterized by a nonspecific acute or recurrent abdominal pain. Case: A 12 years old female with recurrent abdominal pain and palpable mass on her left iliac fossa, that has been noticed a month before consultation. At the emergency service she was checked and complementary exams were requested. US: In the left iliac fossa it was found a solid, rounded formation, with well-defined edges, which moved when the patient changed her position. It showed positive Doppler examination except for a focal hypoechogenic area, which was not vascularized. The structure reminded the spleen echogenicity. CT: normal spleen parenchyma, shape and edges. At left iliac fossa, next to the lower pole of the kidney, a rounded well-defined image which showed heterogeneous EV enhancement with no opacification of the lower corner due to ischemia areas was seen. This image had a vascular hilum that connected to the main spleen vascular hilum. Further images where taken changing the patient position, where the movement of the mass was corroborated. As a result of this exams we realized that the recurrent abdominal pain of the girl was due to an ectopic spleen that has been torsioned - detorsioned several times. Conclusions: Usually, accessory spleen is asymptomatic. Torsion and infarction, rupture with bleeding, and infection with abscess are a very rare complications. Intermittent torsion-detorsion may produce recurrent episodes of abdominal pain caused by short-lasting ischemia of the accessory spleen or from direct mechanical irritation of surrounding organs. To sum up, torsion of an accessory spleen is extremely rare and is still a diagnostic dilemma. So we should consider this any time a patient with abdominal pain (acute or recurrent) comes to us and other diagnosis failed to explain it. Read More

Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020

Authors: Gonzalez Veronica, Aupy Ariane, Lulkin Solange

Keywords: spleen, accesory, torsion