Laparoscopic Resection for Accessory Spleen Torsion in a Pregnant Woman at 16 Weeks' Gestation—A Case Report—

Abstract

Introduction : Torsion of an accessory spleen is a rare cause of acute abdomen, with very few reports during pregnancy.

Case : A 43-year-old pregnant woman at 16 weeks and 5 days of gestation underwent amniocentesis via the right lower abdomen. After returning home, she developed progressive left upper abdominal pain and was emergently transferred to the hospital on the second day of symptom onset. Initial evaluation by obstetrics showed localized tenderness and guarding in the left upper quadrant, leading to a surgical consultation. Contrast-enhanced CT showed a well-circumscribed, hypovascular, 50-mm mass between the gastric fundus and the upper pole of the spleen, along with a cord-like structure extending from the gastrosplenic ligament to the mass. Torsion of an accessory spleen stalk was suspected, and emergency laparoscopic surgery was performed. Intraoperatively, a dark red mass and a twisted vascular bundle continuous with the gastrosplenic ligament were identified. The pedicle was divided at its root, and the mass was resected. The patient was discharged without complications on postoperative day 6.

Conclusion : A rare case of torsion of an accessory spleen occurring at 16 weeks of pregnancy, successfully treated with laparoscopic resection, was described, along with a review of the relevant literature.