PERITONEAL SPLENOSIS: IMPORTANCE OF THE HISTORY OF SPLENECTOMY FOR DIAGNOSIS

Hela Kchir*, Nouha Trad, Wassim Frikha, Dhilel Issaoui and Nadia Maamouri

ABSTRACT

Background: Peritoneal splenosis is a rare entity corresponding to an ectopic auto-transplantation of splenic tissue onto peritoneal cavity. It can be mistaken for carcinomatosis. History of splenectomy is fundamental to make the diagnosis as in our observation reported herein. Case presentation: It was the case of a 55-year-old man complaining of chronic constipation. He reported history of right heart failure and an emergency surgery following a road accident occurring during childhood. Physical examination was normal. There was no anomaly in biological assessment or in colonoscopy. However, abdominal ultrasound showed multiple hypoechoic peritoneal nodules evoking peritoneal carcinomatosis. Tumor markers were normal. Abdominal CT revealed the presence of multiple diffuse intra-peritoneal nodules of similar appearance, taking the contrast in a heterogeneous way at early arterial time with homogenization at portal time. What caught our attention in addition to these nodules was the absence of visualization of the spleen. On patient re-examination, he remembered that he had an emergency splenectomy following abdominal trauma caused by her accident when he was seven years. Thus, the diagnosis of peritoneal splenosis was strongly evoked but surgical biopsies were impossible. An abdominal CT control realised six months later, showed an absolute stability of the aspect of peritoneal nodules confirming thus the diagnosis of peritoneal splenosis basing besides on the powerful argument of history of splenectomy. Conclusion: Our observation points out that peritoneal splenosis should always be suspected for any patient with a history of splenic trauma or splenectomy presenting with peritoneal nodules at imaging.

Keywords: Splenosis, carcinomatosis, splenectomy.