Abstract
A 44-year-old woman presented to our institution with a 3-day history of left-sided abdominal pain accompanied by fever and vomiting. Abdominal computed tomography (CT) with intravenous contrast revealed a well-defined non-enhancing mass in the left abdomen, measuring 5 cm at the largest diameter with a whorl of a fascicular structure extending to the splenic artery. Contrast-enhanced CT obtained 4 years previously showed enhancement of the mass and fascicular structure. The mass was thought to represent ischemia due to a twisted vascular pedicle. An infarcted accessory spleen was diagnosed and laparoscopy was performed. We found a dark-red accessory spleen surrounded by the greater omentum, twisted on its vascular pedicle and strangulated. The pedicle was dissected and the accessory spleen was extracted. The postoperative course was uneventful and the patient was discharged on postoperative day 4. Accessory spleen located in the greater omentum has no supporting tissue and pedicle torsion rarely occurs, especially in cases with sizes exceeding 4 cm. We present a case and a review of the relevant literature.
