P5107 - A Case of Reappearance of the Long Lost Spleen

Justeena Joseph, MD¹, Jiya Mulayamkuzhiyil, MD², Jasbir Singh, MD³, Ivan Kharchenko, MD⁴, Nadia Khan, MBBS⁵, Papiya Begum, MD³, Zubin Tharayil, MD³, Prakash Viswanathan, MD, FACG^3
1Long Island Community Hospital - NYU Langone Health System, New Hyde Park, NY; ²Long Island Community Hospital - NYU Langone Health System, Middle Island, NY; ³Long Island Community Hospital - NYU Langone Health System, Patchogue, NY; ⁴Long Island Community Hospital - NYU Langone Health System, Bellport, NY; ⁵Fatima Jinnah Medical University, Holbrook, NY

Introduction: Splenosis is a benign condition characterized by disseminated splenic tissue in a patient who has had traumatic splenic rupture or splenectomy. It is a rare condition and diagnosis is often challenging as it can mimic malignancy. We present a patient who presented with pyrexia of unknown origin and was incidentally found to have abdominal splenosis.

Case Description/Methods: A 54-year-old male with past medical history of splenectomy done at the age of 12 years presented to the ED with sepsis in the setting of a recent tick-borne infection. Given asplenia and an initial blood picture consistent with hemolysis, the patient was prophylactically started on treatment for babesiosis, however, treatment was discontinued once the workup for tick-borne illnesses came back negative. During the hospital course, the patient was found to have an incidental finding of nodular splenosis throughout the abdomen on CT imaging. The patient had a protracted course of febrile illness with no clear source. A biopsy of the nodular lesions was performed which was consistent with splenosis.

Discussion: Splenosis is an acquired ectopic auto-transplantation of splenic tissue following traumatic splenic rupture or splenectomy. Splenosis is reported in 25% of patients undergoing splenectomy following traumatic splenic injury. About 65% of splenosis cases are abdominopelvic with most common locations being parietal peritoneum, mesentery, greater omentum, serosal surface of the small and large bowel, and diaphragmatic surface. The pathogenesis include spillage of splenic pulp contents into surrounding cavities, hematogenous spread, or tissue growth in response to hypoxia. Patients are usually asymptomatic and splenosis is often incidentally found on imaging, with an average interval of two decades from the initial inciting event to diagnosis. The diagnosis can be made with CT, conventional MRI, and ultrasound. Nuclear scintigraphic studies help in differentiating splenosis from other malignant conditions. Biopsy of splenic nodules is rarely performed. The splenic nodules are insufficient to provide sufficient immunity against overwhelming post-splenectomy infections. The splenic tissue is non-invasive and does not warrant surgical removal unless complications ensue. Differential diagnosis of splenosis include accessory spleen, peritoneal carcinomatosis, and abdominal lymphoma. Physicians should consider splenosis in the differential diagnosis of soft tissue abdominal nodules in a patient with prior history of splenectomy.







Disclosures:


Justeena Joseph, MD¹, Jiya Mulayamkuzhiyil, MD², Jasbir Singh, MD³, Ivan Kharchenko, MD⁴, Nadia Khan, MBBS⁵, Papiya Begum, MD³, Zubin Tharayil, MD³, Prakash Viswanathan, MD, FACG³. P5107 - A Case of Reappearance of the Long Lost Spleen, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.