title: Spontaneous hemorrhage from splenic tissue 13 years after total splenectomy: report of a case.
abstract: A 33-year-old man suffered sudden abdominal distension without traumatic episodes. He had undergone total splenectomy for hereditary spherocytosis 13 years ago. He was in shock, and his hemoglobin level was 10.5 g/dl. Contrast enhanced computed tomography revealed a giant mass in the left upper abdomen and extravasation of the contrast material into the mass. Excision of the mass was performed, and microscopic examination showed a giant hematoma surrounded by normal splenic tissue. We speculated that an accessory spleen or splenosis had enlarged for the 13 years and ruptured. The patient remained asymptomatic 4 months after the surgery. Spontaneous hemorrhage from accessory spleens or splenosis is extremely rare, and relevant case reports suggest that surgical resection of bleeding sites yields favorable prognosis although preoperative qualitative diagnosis seems to be difficult.
authors.affiliation: Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan. qwerty75568@yahoo.co.jp.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Maki
authors.affiliation: Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan. m-oumi@kushiro.jrc.or.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Omi
authors.affiliation: Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan. mimihanapuku@gmail.com.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ishii
authors.affiliation: Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan. kaneche@monasakmay.onmicrosoft.com.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kaneko
authors.affiliation: Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan. misuken@mtb.biglobe.ne.jp.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Misu
authors.affiliation: Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan. inomata@kushiro.jrc.or.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Inomata
authors.affiliation: Department of Pathology, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan. tateno-m@kushiro.jrc.or.jp.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Tateno
authors.affiliation: Department of Surgery, Kushiro Red Cross Hospital, 21-14, Shineichyo, Kushiro, Hokkaido, 085-8512, Japan. knihei@kushiro.jrc.or.jp.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Nihei
keywords: Accessory spleen; Hemorrhage; Rupture; Splenectomy; Splenosis