Accessory Spleen in the Greater Omentum: Embryology and Revisited Prevalence Rates

Purpose: To investigate in a large sample the prevalence rates of accessory spleens located in the greater omentum and to explain the embryological background and the vascular supply of this rare congenital disorder. Methods: Evaluation of the presence of accessory spleens located in the greater omentum was performed in 5 different international anatomical centers investigating a total of 1,045 body donors. Arterial and venous blood supply and the precise location of the respective vasculature within the splenic ligaments are described based on dissection of this rare condition in a male specimen. Results: The reported prevalence rates from 5 different centers were: 0.5% (out of 380 body donors), 0% (out of 230 donors), 0% (out of 200 donors), 2% (out of 200 donors), and 0% (out of 35 donors). The cumulative prevalence rate obtained from 1,045 anatomical dissections was 0.6%. The identified accessory spleen measured 3 × 3 × 2.5 cm and was located in the left upper abdominal quadrant. A vascular stag 7.5 cm in length was identified within the gastro-splenic ligament, containing an artery and a vein piercing the greater omentum from posterior. Conclusion: An accessory spleen located in the greater omentum is a rare congenital disorder. Physicians should be aware of the fact that in patients without any representative symptom history a nodular mass located within the greater omentum could be an accessory spleen.

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Laparoscopic Resection of a Left Upper Quadrant Mass Leading to a Surprise Diagnosis

Case Reports in Surgery ◽

10.1155/2020/8365061 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Hugo J. R. Bonatti ◽

Reinhardt O. Sahmel ◽

Rodrigo B. Erlich

Keyword(s):

Adrenal Gland ◽

Rare Condition ◽

Accessory Spleen ◽

Gastric Fundus ◽

Side Branch ◽

Traumatic Rupture ◽

Left Adrenal Gland ◽

Dense Adhesion ◽

Splenic Vessels ◽

Accessory Spleens

Background. Resplenectomy is most commonly done for the treatment of recurrent idiopathic thrombocytopenic purpura (ITP) refractory to medical management due to the regrowth of a missed accessory spleen. Case Report. A 66-year-old male had undergone open splenectomy for traumatic rupture 40 years ago. He presented with a leiomyosarcoma of his leg, which was surgically removed. When he developed metastatic disease, chemotherapy was started. He developed left upper quadrant pain, and on CT scan, a 5 cm mass compatible with a sarcoma was found between the tail of the pancreas and the left adrenal gland. During laparoscopy, dense adhesion of the omentum to the abdominal wall and the stomach from his previous splenectomy was divided. The lesser sac was opened through the gastrocolic ligament, and the splenic flexure was taken down. Superior and dorsal to the tail of the pancreas next to the left adrenal gland, the mass was identified and carefully dissected out. The vascular pedicle, which originated from a side branch of the splenic vessels at the tail of the pancreas, was stapled. The gastric fundus showed multiple nodules, and therefore, a modified sleeve gastrectomy was done; also, a 2 cm nodule in segment 5 of the liver and an omental nodule were removed. The tumors and gastrectomy specimen were placed in an endobag and removed through a periumbilical mini-incision. The patient recovered without any complications from the procedure and his LUQ pain resolved. Pathology revealed no sarcoma metastases but accessory spleens in all specimens. Discussion. Splenosis with multiple implants within the abdomen after splenectomy for trauma is a rare condition. In our patient, this seems to have been triggered by chemotherapy for his sarcoma resulting in extramedullary hemopoiesis. Laparoscopic removal of accessory spleens can be safely done.

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A Progressive Huge Accessory Spleen in the Greater Omentum

Case Reports in Gastroenterology ◽

10.1159/000504433 ◽

2019 ◽

Vol 13 (3) ◽

pp. 539-543

Author(s):

Hirokazu Matsuzawa ◽

Shinya Munakata ◽

Hirotaka Momose ◽

Yuki Tsuchiya ◽

Shun Ishiyama ◽

...

Keyword(s):

Preoperative Diagnosis ◽

Laparoscopic Resection ◽

English Literature ◽

Rare Condition ◽

Accessory Spleen ◽

Japanese Woman ◽

Emission Tomography ◽

Greater Omentum ◽

Positron Emission ◽

History Of

Huge accessory spleen (AS) is a rare condition difficult to diagnose. We recently treated a Japanese woman with a progressive huge AS. She had a history of aortic valve replacement for aortic stenosis 1 month prior. At that time, a 4-cm AS had been detected by the preoperative computed tomography (CT). This mass was a progressive tumor which grew to 7 cm over the course of 3 months. Thus, we performed surgery with a preoperative diagnosis of huge AS by CT and positron emission tomography. A laparoscopic resection was performed considering the risk of torsion, spontaneous rupture, or hemorrhage. The final pathological diagnosis was AS. This is the first reported case in the English literature of progressive AS with no symptoms at the initial presentation that was treated with laparoscopic resection.

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A rare case of symphalangism of bilateral interphalangial joint of thumbs: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20201417 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1307

Author(s):

Anil Kumar

Keyword(s):

Case Report ◽

Functional Impairment ◽

Rare Case ◽

Surgical Intervention ◽

Rare Condition ◽

Congenital Disorder ◽

Rare Congenital Disorder ◽

Hands And Feet

Symphalangism is rare congenital disorder characterised by ankylosis of interphalangeal joints of hands and feet. The fusion can involve the proximal or the distal joints; however, involvement of the proximal interphalangeal joints is more common. There may other associated skeletol and non-skeletol abnormalities. Here the author reports a 14 year old girl with symphalangism involving the interphalangeal joints of the thumbs of bilateral hand. She did not have any functional impairment and hence no medical or surgical intervention was performed. As involvement of thumbs is very rare condition, author would like to report it.

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Impact of PET data driven respiratory motion correction and BSREM reconstruction of 68Ga-DOTATATE PET/CT for differentiating neuroendocrine tumors (NET) and intrapancreatic accessory spleens (IPAS)

Scientific Reports ◽

10.1038/s41598-020-80855-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Virginia Liberini ◽

Fotis Kotasidis ◽

Valerie Treyer ◽

Michael Messerli ◽

Erika Orita ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Motion Correction ◽

Accessory Spleen ◽

Pancreatic Neuroendocrine Tumor ◽

Reconstruction Algorithm ◽

Data Driven ◽

Operating Characteristics ◽

Quantitative Pet ◽

Pet Ct ◽

Accessory Spleens

AbstractTo evaluate whether quantitative PET parameters of motion-corrected 68Ga-DOTATATE PET/CT can differentiate between intrapancreatic accessory spleens (IPAS) and pancreatic neuroendocrine tumor (pNET). A total of 498 consecutive patients with neuroendocrine tumors (NET) who underwent 68Ga-DOTATATE PET/CT between March 2017 and July 2019 were retrospectively analyzed. Subjects with accessory spleens (n = 43, thereof 7 IPAS) and pNET (n = 9) were included, resulting in a total of 45 scans. PET images were reconstructed using ordered-subsets expectation maximization (OSEM) and a fully convergent iterative image reconstruction algorithm with β-values of 1000 (BSREM1000). A data-driven gating (DDG) technique (MOTIONFREE, GE Healthcare) was applied to extract respiratory triggers and use them for PET motion correction within both reconstructions. PET parameters among different samples were compared using non-parametric tests. Receiver operating characteristics (ROC) analyzed the ability of PET parameters to differentiate IPAS and pNETs. SUVmax was able to distinguish pNET from accessory spleens and IPAs in BSREM1000 reconstructions (p < 0.05). This result was more reliable using DDG-based motion correction (p < 0.003) and was achieved in both OSEM and BSREM1000 reconstructions. For differentiating accessory spleens and pNETs with specificity 100%, the ROC analysis yielded an AUC of 0.742 (sensitivity 56%)/0.765 (sensitivity 56%)/0.846 (sensitivity 62%)/0.840 (sensitivity 63%) for SUVmax 36.7/41.9/36.9/41.7 in OSEM/BSREM1000/OSEM + DDG/BSREM1000 + DDG, respectively. BSREM1000 + DDG can accurately differentiate pNET from accessory spleen. Both BSREM1000 and DDG lead to a significant SUV increase compared to OSEM and non-motion-corrected data.

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Tensor Fasciae Latae Free Flap For Full-Thickness Abdominal Wall Reconstruction Utilized The Greater Omentum As A Vascular Supply

Plastic & Reconstructive Surgery ◽

10.1097/00006534-198504000-00038 ◽

1985 ◽

Vol 75 (4) ◽

pp. 607 ◽

Cited By ~ 2

Author(s):

&NA;

Keyword(s):

Abdominal Wall ◽

Free Flap ◽

Abdominal Wall Reconstruction ◽

Vascular Supply ◽

Greater Omentum ◽

Full Thickness ◽

Tensor Fasciae Latae

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Management of Isolated Capitate Nonunion: A Case Series and Literature Review

Journal of Wrist Surgery ◽

10.1055/s-0038-1651487 ◽

2018 ◽

Vol 07 (05) ◽

pp. 419-423 ◽

Cited By ~ 2

Author(s):

Rishabh Jethanandani ◽

Schneider Rancy ◽

Keith Corpus ◽

Jeffrey Yao ◽

Scott Wolfe

Keyword(s):

Literature Review ◽

Internal Fixation ◽

Bone Grafting ◽

Relevant Literature ◽

Case Series ◽

Rare Condition ◽

Vascular Supply ◽

Autogenous Bone ◽

Rare Injury ◽

Autogenous Bone Grafting

Background Isolated capitate nonunion is rare. No consensus on the appropriate treatment for this condition exists. Case Description We reported two cases of capitate fracture nonunion presenting several months after untreated high-impact wrist trauma. Treatment was delayed as both patients' nonunions were missed on conventional radiographs. Both were ultimately diagnosed with advanced imaging and successfully treated with internal fixation and autogenous bone grafting. The relevant literature pertaining to capitate nonunion was reviewed. Literature Review Immobilization and internal fixation with bone grafting for capitate nonunion have been described in the literature. Loss of vascular supply and progression to avascular necrosis is a concern after capitate nonunion. Clinical Relevance We present two cases and review the literature on the diagnosis and treatment of this rare injury to guide management. Internal fixation with autogenous bone grafting could play a role in management for this rare condition.

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Topsy-turvy: turning the counter-current heat exchange of leatherback turtles upside down

Biology Letters ◽

10.1098/rsbl.2015.0592 ◽

2015 ◽

Vol 11 (10) ◽

pp. 20150592 ◽

Cited By ~ 6

Author(s):

John Davenport ◽

T. Todd Jones ◽

Thierry M. Work ◽

George H. Balazs

Keyword(s):

Heat Exchangers ◽

Venous Blood ◽

Vascular Supply ◽

The Body ◽

Leatherback Turtles ◽

The Core ◽

Arterial Blood ◽

Hip Muscles ◽

Counter Current ◽

Current Heat

Counter-current heat exchangers associated with appendages of endotherms feature bundles of closely applied arteriovenous vessels. The accepted paradigm is that heat from warm arterial blood travelling into the appendage crosses into cool venous blood returning to the body. High core temperature is maintained, but the appendage functions at low temperature. Leatherback turtles have elevated core temperatures in cold seawater and arteriovenous plexuses at the roots of all four limbs. We demonstrate that plexuses of the hindlimbs are situated wholly within the hip musculature, and that, at the distal ends of the plexuses, most blood vessels supply or drain the hip muscles, with little distal vascular supply to, or drainage from the limb blades. Venous blood entering a plexus will therefore be drained from active locomotory muscles that are overlaid by thick blubber when the adults are foraging in cold temperate waters. Plexuses maintain high limb muscle temperature and avoid excessive loss of heat to the core, the reverse of the accepted paradigm. Plexuses protect the core from overheating generated by muscular thermogenesis during nesting.

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