title: Right sided spleen laying retro-duodenal: A case report and review of the literature.
abstract: BACKGROUND
  Unlike left sided accessory spleen that are seen in 10-30% of cases at autopsy, cases of right accessory spleens are extremely rare. This congenital body of healthy splenic tissue simulates tumors from neighboring organs and presents a challenge in formulating a differential diagnosis.
  
  
  METHODS
  We present the case of a patient whose CT scan of the abdomen showed a large mass, 11×8cm, arising retro-duodenal and lying just anterior to the right kidney. To the best of our knowledge, this is the only case where the accessory spleen was found retro-duodenal, directly anterior to the kidney and completely separate from the supra-renal gland. The chief complaint of the patient was right upper quadrant pain, radiating to the back, and colicky in nature. The patient was diagnosed with duodenal gastro-intestinal stromal tumor and a retro-peritoneal sarcoma. The mass was removed via a Kocher's incision and immunohistological examination showed that it was a right sided accessory spleen. The patient's left sided spleen appeared normal.
  
  
  CONCLUSIONS
  Efforts to distinguish an accessory spleen from a retroperitoneal tumor with available scans, percutaneous biopsy or biochemical tests are inconclusive. Differential diagnosis between a retroperitoneal tumor and an accessory spleen can only be made after surgical exploration.
  
  
  CONCLUSIONS
  This case highlights the fact that surgeons should consider the possibility of an accessory spleen when making a differential diagnosis of retroperitoneal tumors.
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: drravimaharajuwi@gmail.com.
authors.forename: Ravi
authors.initials: R
authors.lastname: Maharaj
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: wtramcharan@hotmail.com.
authors.forename: Wesley
authors.initials: W
authors.lastname: Ramcharan
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: formermcos@hotmail.com.
authors.forename: Paramanand
authors.initials: P
authors.lastname: Maharaj
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, Eric Williams Medical Sciences Complex, Champ Fleurs, Trinidad and Tobago. Electronic address: wesgreavesmd@gmail.com.
authors.forename: Wesley
authors.initials: W
authors.lastname: Greaves
authors.affiliation: Division of Oncology, Siteman Cancer Center, Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA. Electronic address: wwarner@dom.wustl.edu.
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Warner
keywords: Accessory spleen; Case report; Retroperitoneal mass; Spleen