Laparoscopic management of pelvic splenosis
A 49-year-old Korean menopausal woman was referred to our hospital for lower abdominal pain and incidentally detected ovarian mass. She had undergone a laparotomy because of a traffic accident 25 years previously, and at that time a splenectomy had been performed to remove a ruptured spleen.\nOn physical examination, the patient had left lower abdominal tenderness without specific signs of peritoneal irritation or pelvic symptoms. A gynecological ultrasonogram showed a normal uterus and right ovary in terms of size and shape. However, a 45 × 30 mm homogeneous cystic mass adhered to the left ovary without ascites. Hematological values and serum levels of CA-125 and CA-19-9 were within the normal ranges. Abdominal pelvic computerized tomography, pelvic magnetic resonance imaging and chest computerized tomography scans revealed a 50 mm cystic mass in the left pelvic cavity and several small pleural nodules in the left lower lobe of the lung. We performed laparoscopic surgery to confirm the final diagnosis and relieve the patient's persistent abdominal pain. Adhesions of the greater omentum and the anterior wall of the abdominal cavity were found along the ligamentum teres. Adhesiolysis was performed using a harmonic scalpel (Ultracision Harmonic Scalpel, Ethicon Endo Surgery, Cincinnati, OH, USA). The lesions varied in size, were a purplish color, and were lobulated and hypervascularized along the mesocolon of the bowel from the sigmoid colon to the rectum (). The splenic nodules were entirely removed after dissecting them from the bowel. Rectum tearing was observed in the serosal layer, and primary closure was performed using 3-0 polyglactin 910 sutures (Vicryl, Ethicon Inc., Somerville, NJ, USA). In the pelvic cavity, 50×30 mm splenic nodules were seen on the upper side of the left uterosacral ligament, ureter, and lower lateral side of the left ovary (). The left pelvic wall peritoneum was carefully dissected and the splenic nodules were removed after locating the ureter in the retroperitoneal area. The largest mass adhered to the mesocolon, and was sent for frozen section examination and confirmation as normal splenic tissue (). The nodules were placed in an endo-bag (Lap-bag, Sejong Medical, Paju, Korea) and retrieved via a 12 mm trocar. The patient recovered without any complications and was discharged on the eighth postoperative day. The patient is currently being followed up without any other complications or specific symptoms.