SDIAP SENEC 2010 case 374 Ludmila Boudová Plzeń
Mentální retardace, epilepsie
Medikace1. Mysoline (primidone)2. Sodanton (diphenylhydantoine)3. Apo-Haloperidol (butyrofenon. incis. neuroleptikum)4. Rivotril (clonazepam)5. Nitrazepam F 6. Apaurin (diazepam) při záchvatu7. Topamax (topiramat)8. Tisercin (levopromazin)
Flavobion, Ascorutin, Pancreolan
Vomitus, obstipace, zvětšení rezistence v levém podbřišku4 dny
Muž, 23 let
Case history• Born 1982• Children cerebral palsy, left sided hemiparesis• Epilepsy, mental retardation• 1992 - trauma - spleen laceration, renal
contusion, brain commotion; splenectomy• 1993 – first operation of splenosis
in the abdominal scar • corrective operations of lower extremities• 2005 – suspected hernia in cicatrice;
second operation for splenosis• 2010 - alive and well
Splenosis
Autotransplantation of splenic tissuefollowing abdominal trauma or surgery
LocalizationCommon: peritoneumRare: pericardium, pleura, retroperitoneum, subcutis
May be cystic
Splenosis• Diagnostic problem - clinical, imaging
• Case history
• Mostly: small, asymptomatic
• Rarely: intestinal obstruction, mass effect on abdominal organs, pelvic pain, bleeding
Splenosis - differential diagnosis
Splen accessorius = spleniculus
Splenic hilus, lig. gastrosplenicum
Tail of pancreas, mesentery
Tumours, metastasis, endometriosis, incarcerated hernia…
Subcutaneous splenosis of the abdominal wall
Am J Dermatopathol. 2006 Jun;28(3):208-10.
Boudová L, Kazakov DV, Hes O, Zahálka M, Mukensnabl P, Kocová J, Michal M.
Splenóza jater u nemocného po operaci seminomu. Rozhl. Chir., 2005, 84, 9, s. 452-455.
Třeška V., Skalický T., Chudáček Z., Boudová L.,Hes. O