Tognarelli A, Faggioni L, Erba AP, Faviana P, Durante J, Manassero F, Selli C. Robotically assisted removal of pelvic splenosis fifty-six years after splenectomy: A case report. World J Clin Cases 2021; 9(12): 2868-2873 [PMID: 33969071 DOI: 10.12998/wjcc.v9.i12.2868]
Corresponding Author of This Article
Alessio Tognarelli, MD, Resident, Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, Via Savi 10, Pisa 56126, Italy. alessio.tognarelli@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 26, 2021; 9(12): 2868-2873 Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2868
Robotically assisted removal of pelvic splenosis fifty-six years after splenectomy: A case report
Alessio Tognarelli, Lorenzo Faggioni, Anna Paola Erba, Pinuccia Faviana, Jacopo Durante, Francesca Manassero, Cesare Selli
Alessio Tognarelli, Jacopo Durante, Francesca Manassero, Cesare Selli, Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, Pisa 56126, Italy
Lorenzo Faggioni, Department of Translational Research and New Technologies in Medicine and Surgery, Section of Diagnostic and Interventional Radiology, University of Pisa, Pisa 56126, Italy
Anna Paola Erba, Department of Translational Research and New Technologies in Medicine and Surgery, Section of Nuclear Medicine, University of Pisa, Pisa 56126, Italy, Pisa 56126, Italy
Pinuccia Faviana, Department of Surgical, Medical and Molecular Pathology and Critical Area, Section of Pathology, University of Pisa, Pisa 56126, Italy
Author contributions: Tognarelli A contributed to data acquisition, reviewed the literature and drafted the manuscript; Faggioni L and Erba AP analysed and interpreted images and contributed to figure elaboration; Faviana P performed the histological diagnosis and contributed to the multidisciplinary evaluation; Manassero F contributed to the diagnosis and multidisciplinary evaluation; Durante J contributed to patient’s treatment and data acquisition; Selli C contributed to patient’s treatment, reviewed the literature and drafted the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alessio Tognarelli, MD, Resident, Department of Translational Research and New Technologies in Medicine and Surgery, Section of Urology, University of Pisa, Via Savi 10, Pisa 56126, Italy. alessio.tognarelli@gmail.com
Received: November 29, 2020 Peer-review started: November 29, 2020 First decision: December 24, 2020 Revised: December 26, 2020 Accepted: January 27, 2021 Article in press: January 27, 2021 Published online: April 26, 2021
Abstract
BACKGROUND
‘Splenosis’ is defined as the autotransplantation of splenic tissue following trauma or surgery, usually in the form of intraperitoneal nodules. The proliferation of imaging techniques has resulted in increased unexpected discoveries of splenosis nodules, and achieving a differential diagnosis can be challenging. Nuclear medicine studies have been playing an increasingly important role in this process, but the clinical significance of asymptomatic nodules remains uncertain.
CASE SUMMARY
We present a case of pelvic splenosis in a 73-year-old man diagnosed 56 years after a splenectomy during a computed tomography (CT) follow-up for B-cell lymphoma, presenting intense contrast enhancement of an 18 mm nodule in the right recto-vesical space. 18F-fluorodeoxyglucose demonstrated weak metabolic activity. Since histological diagnosis was deemed necessary, the nodule was easily removed with robotically assisted laparoscopy, together with another 6 mm left a paracolic lesion. The latter was previously undiagnosed but retrospectively visible on the CT scan.
CONCLUSION
In a patient requiring differential diagnosis of splenosis nodules from lymphoma recurrence, the robotic approach provided a safe en bloc removal with short hospitalization. The Da Vinci Xi robot was particularly helpful because its optics can be introduced from all ports, facilitating visualization and lysis of multiple intra-abdominal adhesions.
Core Tip: Splenosis consists in the autotrasplantation of splenic tissue caused by trauma or surgery, usually in the form of asymptomatic intraperitoneal nodules. They usually present intense enhancement at computed tomography scan and nuclear medicine studies have an increasing role in diagnosis. When histological diagnosis is deemed necessary robotically assisted laparoscopic surgery can provide safe en bloc removal with minimal invasiveness.
