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Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary?

Abstract

Background

Some one-fifth of patients may have accessory spleens (AcS) and require their removal at the time of splenectomy to achieve and maintain hematological response. The purpose of this study was to evaluate the benefit of computed tomography (CT) in patients undergoing laparoscopic splenectomy (LS).

Methods

All patients who required splenectomy were offered LS and underwent preoperative contrast-enhanced CT scan to detect and locate AcS. The surgeon was not blinded to the result of the CT scan. Patients were followed up to determine if there was recurrent disease.

Results

Between 2000 and 2007, 58 consecutive patients (31 men) were referred for splenectomy and all underwent LS. Preoperative CT scan detected 11 AcS in 11 patients (19%), of which 9 were confirmed during LS; the remaining 2 patients suffered with ITP preoperatively and had a good hematologic response to LS. At LS, 14 AcS were found in 13 patients (22%), of which 4 patients had negative preoperative CT scan; those additional AcS were readily found and were located close to the lower pole or hilum of the spleen. All removed AcS were confirmed histologically. In one patient who had LS and removal of AcS for ITP a further AcS within the tail of the pancreas was detected 1 year postoperatively on CT after thrombocytopenia relapsed. The sensitivity and specificity of CT scan for the detection of AcS were 60% and 95.6%, and the corresponding values for laparoscopy were 93.3% and 100%, respectively. Pairwise comparison of the ROC curves identified laparoscopy to be associated with a significantly higher area under the curve compared with CT scan (0.967 vs. 0.673; P = 0.004).

Conclusions

Accessory spleens can be readily detected at laparoscopy in the vicinity of the spleen; preoperative CT scan for their detection and localization may not be necessary.

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Disclosures

All of the named authors, Conal Quah, Georgios D. Ayiomamitis, Asim Shah, and Basil J. Ammori, have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Basil J. Ammori.

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Quah, C., Ayiomamitis, G.D., Shah, A. et al. Computed tomography to detect accessory spleens before laparoscopic splenectomy: is it necessary?. Surg Endosc 25, 261–265 (2011). https://doi.org/10.1007/s00464-010-1171-2

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Keywords

  • Accessory spleen
  • Laparoscopy
  • Splenectomy
  • Computed tomography