Torsion of accessory spleen mimicking acute appendicitis in a 4-year-old female: A case report

Introduction

Accessory spleens are masses of splenic tissue commonly located near the splenic hilum and found in 10 %–30 % of the population. Accessory spleens can be either solitary or multiple. Due to their variable location, complications of accessory spleens can mimic other acute abdominal conditions.

Case presentation

A 4-year-old girl presented with classical signs and symptoms of acute appendicitis of two days of duration. Physical examination showed an uncomfortable appearing girl with a slight tachycardia and tachypnea. She had discrete tenderness to palpation over the right iliac fossa. Complete blood count (CBC) and electrolyte levels were within normal limits. Abdominal ultrasound findings were not contributory. Because of the unavailability of other imaging studies and the persistence of her pain she was taken to the operating room with a presumed diagnosis of early acute appendicitis.The abdomen was entered through a transverse incision in the right lower quadrant. An encapsulated, rounded, 4 x 4 x 5-cm solid mass was identified on the mesenteric side of the terminal ileum. The mass had a 270-degree torsion around its pedicle. The appendix appeared normal. The pedicle of the solid mass was ligated, the mass was fully excised and was sent for a pathology analysis. The histopathological examination showed infarcted splenic tissue, consistent with torsion of an accessory spleen. The postoperative course was uneventful, and the patient was discharged home on the third postoperative day.

Conclusion

Torsion of an accessory spleen should be considered in the differential diagnosis of acute abdomen in children and adolescents, particularly in those with inconclusive imaging studies.