Accessory Spleen: A Case Report Emphasizing Clinical Recognition and Surgical Management
Abstract
Abstract; Accessory spleens are found in approximately 10–30% of the population and are usually clinically silent” [1].Accessory spleens, or splenules, are congenital foci of splenic tissue located outside the normal splenic parenchyma. They are often asymptomatic and discovered incidentally during imaging for unrelated issues. In patients with a history of splenectomy, the likelihood of encountering an accessory spleen increases. This review discusses the presentation, diagnosis, surgical management, and postoperative care of a patient with an enlarged accessory spleen
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Available online at www.rajournals.in RA JOURNAL OF APPLIED RESEARCH ISSN: 2394-6709 DOI:10.47191/rajar/v11i10.10 Volume: 11 Issue: 10 October 2025 International Open Access Impact Factor8.553 Page no.- 907-908 907 Sarah Saud Alharbi1, RAJAR Volume 11 Issue 10 October 2025 Accessory Spleen: A Case Report Emphasizing Clinical Recognition and Surgical Management Sarah Saud Alharbi1, Kamal Mohammad AlDammad2, Nouf Mohammed A. Aldhamdi3 1Saudi Board Program Director, Head Department of General Surgery. 2Consultant of General Surgery 3General Surgery Training Resident. ARTICLE INFO ABSTRACT Published Online: 29 October 2025 Corresponding Author: Sarah Saud Alharbi “Accessory spleens are found in approximately 10–30% of the population and are usually clinically silent” [1]. Accessory spleens, or splenules, are congenital foci of splenic tissue located outside the normal splenic parenchyma. They are often asymptomatic and discovered incidentally during imaging for unrelated issues. In patients with a history of splenectomy, the likelihood of encountering an accessory spleen increases. This review discusses the presentation, diagnosis, surgical management, and postoperative care of a patient with an enlarged accessory spleen. KEYWORDS: Spleen, Splenectomy, Laparoscopy, Pain. INTRODUCTION Accessory spleens are common anatomical variants, present in approximately 10–30% of the population [1]. They are typically located near the splenic hilum, tail of the pancreas, or within the greater omentum. In patients with a history of splenectomy, accessory spleens may serve as functional splenic tissue, potentially leading to persistent or recurrent hematologic conditions. This review aims to highlight the clinical significance of accessory spleens, particularly in post-splenectomy patients. CASE PRESENTATION A 43-year-old woman with a history of splenectomy at age 6 due to trauma presented with sharp left flank pain. Physical examination revealed tenderness in the left upper quadrant without signs of peritoneal irritation. Laboratory tests were unremarkable. Abdominal CT imaging revealed a welldefined mass in the left upper quadrant demonstrating soft tissue enhancement, raising suspicion for an enlarged accessory spleen. The patient underwent laparoscopic excision of the mass, and her postoperative course was uneventful. She was discharged on postoperative day 3 after receiving necessary post-splenectomy vaccinations. (Figure 1: CT imaging of the accessory spleen) DISCUSSION Accessory spleens are often asymptomatic and discovered incidentally during imaging for unrelated issues. However, in post-splenectomy patients, accessory spleens may become symptomatic due to complications such as torsion, hemorrhage, or hyperfunction. For instance, a case report described a 6-year-old child who developed hyperfunction of the accessory spleen 7 years after undergoing splenectomy [2]. Imaging modalities such as CT, MRI, and nuclear scintigraphy are instrumental in diagnosing accessory spleens. CT imaging typically reveals a well-defined, hypervascular mass resembling splenic tissue. In the case presented, CT imaging demonstrated a mass in the left upper
“Accessory Spleen: A Case Report Emphasizing Clinical Recognition and Surgical Management” 908 Sarah Saud Alharbi1, RAJAR Volume 11 Issue 10 October 2025 quadrant with soft tissue enhancement, consistent with an accessory spleen . (Figure 2). Specimen post resection. Laparoscopic excision is the preferred surgical approach for symptomatic accessory spleens due to its minimally invasive nature and favorable recovery profile [3]. Post-splenectomy patients are at increased risk for infections, particularly from encapsulated organisms. Therefore, vaccination against pneumococcus, meningococcus, and Haemophilus influenzae type b is recommended [4]. In the presented case, the patient received the necessary vaccinations before discharge to mitigate this risk. CONCLUSION This case underscores the importance of considering accessory spleens in patients with prior splenectomy who present with abdominal pain. Imaging studies play a crucial role in diagnosis, and laparoscopic excision remains a safe and effective treatment option. Postoperative management should include appropriate vaccinations to protect against infections. REFERENCES 1. Halpert, B., & Gyorkey, F. (1959). Lesions observed in accessory spleens of 311 patients. American Journal of Clinical Pathology, 32(2), 165–168. 2. Harbrecht, B. G., et al. (2014). Hyperfunctioning accessory spleen after splenectomy in a child: A case report. Frontiers in Pediatrics, 2, 127. 3. Kanwal, A., et al. (2021). Laparoscopic excision of accessory spleen in post-splenectomy patients: Case series and literature review. Journal of Minimally Invasive Surgery, 12(3), 101–108. 4. CDC Guidelines for Post-Splenectomy Vaccination, 2020.