title: Torsion of an accessory spleen: a rare case preoperatively diagnosed and cured by single-port surgery.
abstract: We report a very rare case of acute abdomen caused by torsion of an accessory spleen that was preoperatively diagnosed and cured by single-port surgery. A 31-year-old woman was admitted to our hospital with severe left abdominal pain. Physical examination revealed a left upper quadrant abdominal tenderness with voluntary guarding. Ultrasound demonstrated a well-defined round mass isoechoic to the spleen, measuring 3.0 cm in diameter in the left upper quadrant adjacent to the spleen. A contrast-enhanced CT scan showed a normally enhanced spleen and a 3.0 × 3.0, hypodense, non-enhancing mass anterior to the spleen with a twisted funicular structure. Torsion of an accessory spleen was suspected, and emergency single-port surgery was performed. During surgery, a rounded violet mass measuring 3.0 cm in diameter, suggestive of an accessory spleen, with a 1800° torsion around a long vascular pedicle along the left side of the greater omentum was discovered. The mass was removed and post-operative recovery was uneventful. A review of the literature revealed 26 cases (including ours) of torsion of an accessory spleen in English. Even with the recent advances in radiologic imaging modalities, making a preoperative diagnosis of this is difficult and most cases are diagnosed during laparotomy. This is the first report preoperatively diagnosed and cured by single-port surgery. We decided to start the operation by using a single port, not only for cosmetic reasons for this young female patient, but also for final confirmation of our diagnosis. We believe that single-port laparoscopy is valuable as a diagnostic tool as long as safety is assured for patients with acute abdomen. Although torsion of an accessory spleen is extremely rare, it should be considered in the differential diagnosis of acute abdomen in children and young adults.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan. sur150@poh.osaka-med.ac.jp.
authors.forename: Maiko
authors.initials: M
authors.lastname: Ozeki
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan. sur105@poh.osaka-med.ac.jp.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Asakuma
authors.affiliation: Department of Radiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan. rad091@poh.osaka-med.ac.jp.
authors.forename: Nakai
authors.initials: N
authors.lastname: Go
authors.affiliation: Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan. in2121@poh.osaka-med.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ogura
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan. sur129@poh.osaka-med.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan. sur116@poh.osaka-med.ac.jp.
authors.forename: Tetsunosuke
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan. sur122@poh.osaka-med.ac.jp.
authors.forename: Fumitoshi
authors.initials: F
authors.lastname: Hirokawa
authors.affiliation: Department of Radiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan. rad043@poh.osaka-med.ac.jp.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan. sur083@poh.osaka-med.ac.jp.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of Radiology, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan. narumi@poh.osaka-med.ac.jp.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Narumi
authors.affiliation: Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, 569-8686, Japan. higuchi@poh.osaka-med.ac.jp.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, 569-8686, Japan. uchi@poh.osaka-med.ac.jp.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
keywords: Accessory spleen; Acute abdomen; Laparoscopic surgery; Preoperative diagnosis; Single-port surgery; Surgical glove; Torsion