Management of a patient with umbilical hernia and splenosis
EAES Academy. Andrei D. 06/11/24; 422666; P213
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Abstract
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Background
Splenosis is a frequent condition after severe traumatic splenic injuries.
Standard ultrasound and CT scan may not be sufficient to diagnose splenosis.
Scintigraphy with 99mTc-labelled heat- denaturated erythrocytes is the gold standard to diagnose this condition.
Methods
We present a case of a patient with umbilical hernia, who was diagnosed preoperatively by CT scan in another country with multiple abdominal tumors and was indicated for multiple excisions, but he refused. He also adressed our hospital for hernia repair and from medical history we found out that he had a car accident at the age of 6 years and an emergency open splenectomy was performed, having 2 months of hospitalization. Having no images from previous CT scan from the other country, we also performed a complete CT scan witch revealed many abdominal formations, the greatest one having 64/40mm, but a differentiation between tumors and splenosis could not be performed. Unfortunately scintigraphy with 99mTc-labelled heat- denaturated erythrocyte, witch is golden standard for diagnosing splenosis was not available in our country and radiologists recommended contrast ultrasound with Sonovue to be performed.
Results
Contrast ultrasound examination was highly relevant, revealing an extensive splenosis, the greatest formation having 8,7cm in length and a laparoscopic umbilical herniar repair was performed using intraperitoneal mesh and adhesiolysis was also performed. The numerous nodules of splenosis, some of them being tightly attached to bowels were not excised, because they were asymptomatic and they functionally supplemented the lack of the spleen.
Conclusions
Contrast ultrasound investigation was very relevant for diagnosing splenosis in this case, considering that the gold standard scintigraphy with heat-denaturated erythrocytes was not available and allowed the surgeons to focus only on hernia repair and to rule out an oncological condition that would contraindicate hernia repair.
Splenosis is a frequent condition after severe traumatic splenic injuries.
Standard ultrasound and CT scan may not be sufficient to diagnose splenosis.
Scintigraphy with 99mTc-labelled heat- denaturated erythrocytes is the gold standard to diagnose this condition.
Methods
We present a case of a patient with umbilical hernia, who was diagnosed preoperatively by CT scan in another country with multiple abdominal tumors and was indicated for multiple excisions, but he refused. He also adressed our hospital for hernia repair and from medical history we found out that he had a car accident at the age of 6 years and an emergency open splenectomy was performed, having 2 months of hospitalization. Having no images from previous CT scan from the other country, we also performed a complete CT scan witch revealed many abdominal formations, the greatest one having 64/40mm, but a differentiation between tumors and splenosis could not be performed. Unfortunately scintigraphy with 99mTc-labelled heat- denaturated erythrocyte, witch is golden standard for diagnosing splenosis was not available in our country and radiologists recommended contrast ultrasound with Sonovue to be performed.
Results
Contrast ultrasound examination was highly relevant, revealing an extensive splenosis, the greatest formation having 8,7cm in length and a laparoscopic umbilical herniar repair was performed using intraperitoneal mesh and adhesiolysis was also performed. The numerous nodules of splenosis, some of them being tightly attached to bowels were not excised, because they were asymptomatic and they functionally supplemented the lack of the spleen.
Conclusions
Contrast ultrasound investigation was very relevant for diagnosing splenosis in this case, considering that the gold standard scintigraphy with heat-denaturated erythrocytes was not available and allowed the surgeons to focus only on hernia repair and to rule out an oncological condition that would contraindicate hernia repair.
Background
Splenosis is a frequent condition after severe traumatic splenic injuries.
Standard ultrasound and CT scan may not be sufficient to diagnose splenosis.
Scintigraphy with 99mTc-labelled heat- denaturated erythrocytes is the gold standard to diagnose this condition.
Methods
We present a case of a patient with umbilical hernia, who was diagnosed preoperatively by CT scan in another country with multiple abdominal tumors and was indicated for multiple excisions, but he refused. He also adressed our hospital for hernia repair and from medical history we found out that he had a car accident at the age of 6 years and an emergency open splenectomy was performed, having 2 months of hospitalization. Having no images from previous CT scan from the other country, we also performed a complete CT scan witch revealed many abdominal formations, the greatest one having 64/40mm, but a differentiation between tumors and splenosis could not be performed. Unfortunately scintigraphy with 99mTc-labelled heat- denaturated erythrocyte, witch is golden standard for diagnosing splenosis was not available in our country and radiologists recommended contrast ultrasound with Sonovue to be performed.
Results
Contrast ultrasound examination was highly relevant, revealing an extensive splenosis, the greatest formation having 8,7cm in length and a laparoscopic umbilical herniar repair was performed using intraperitoneal mesh and adhesiolysis was also performed. The numerous nodules of splenosis, some of them being tightly attached to bowels were not excised, because they were asymptomatic and they functionally supplemented the lack of the spleen.
Conclusions
Contrast ultrasound investigation was very relevant for diagnosing splenosis in this case, considering that the gold standard scintigraphy with heat-denaturated erythrocytes was not available and allowed the surgeons to focus only on hernia repair and to rule out an oncological condition that would contraindicate hernia repair.
Splenosis is a frequent condition after severe traumatic splenic injuries.
Standard ultrasound and CT scan may not be sufficient to diagnose splenosis.
Scintigraphy with 99mTc-labelled heat- denaturated erythrocytes is the gold standard to diagnose this condition.
Methods
We present a case of a patient with umbilical hernia, who was diagnosed preoperatively by CT scan in another country with multiple abdominal tumors and was indicated for multiple excisions, but he refused. He also adressed our hospital for hernia repair and from medical history we found out that he had a car accident at the age of 6 years and an emergency open splenectomy was performed, having 2 months of hospitalization. Having no images from previous CT scan from the other country, we also performed a complete CT scan witch revealed many abdominal formations, the greatest one having 64/40mm, but a differentiation between tumors and splenosis could not be performed. Unfortunately scintigraphy with 99mTc-labelled heat- denaturated erythrocyte, witch is golden standard for diagnosing splenosis was not available in our country and radiologists recommended contrast ultrasound with Sonovue to be performed.
Results
Contrast ultrasound examination was highly relevant, revealing an extensive splenosis, the greatest formation having 8,7cm in length and a laparoscopic umbilical herniar repair was performed using intraperitoneal mesh and adhesiolysis was also performed. The numerous nodules of splenosis, some of them being tightly attached to bowels were not excised, because they were asymptomatic and they functionally supplemented the lack of the spleen.
Conclusions
Contrast ultrasound investigation was very relevant for diagnosing splenosis in this case, considering that the gold standard scintigraphy with heat-denaturated erythrocytes was not available and allowed the surgeons to focus only on hernia repair and to rule out an oncological condition that would contraindicate hernia repair.
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