# Torsion of an accessory spleen: a rare case preoperatively diagnosed and cured by single-port surgery

## TL;DR

A rare case of accessory spleen torsion was diagnosed before surgery and treated with a minimally invasive single-port procedure in a young woman.

## Contribution

This is the first reported case of torsion of an accessory spleen diagnosed preoperatively and treated with single-port surgery.

## Key findings

- A 31-year-old woman with acute abdomen was diagnosed with torsion of an accessory spleen using imaging and confirmed during single-port surgery.
- The accessory spleen was successfully removed with uneventful post-operative recovery.
- Only 26 cases of torsion of an accessory spleen have been reported in English literature, with most diagnosed during laparotomy.

## 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.

The online version of this article (doi:10.1186/s40792-015-0101-x) contains supplementary material, which is available to authorized users.