PMC10307128_01
PMC10307128_02
(a) Ecchymosis present on the medial side of the left lower extremity. (b) Petechial rash noted on the lateral portion of the left lower extremity.
CRIHEM2023-9714457.001.jpg
PMC10307128_02_CRIHEM2023-9714457.001.jpg
fig1
Physical examination was notable for a large bruise on his medial left leg and petechiae on the bilateral lower extremities (Figures 1(a) and 1(b)) but was otherwise unremarkable.
(a) Laparoscopic view of extensive omental adhesions present at the site of prior splenic injury. (b) Multiple sites of splenosis located around the spleen, left paracolic gutter, anterior peritoneum, and mesentery. (c) Multiple sites of revascularized ectopic splenosis.
CRIHEM2023-9714457.002.jpg
PMC10307128_02_CRIHEM2023-9714457.002.jpg
fig2
Upon assessment of the spleen at the beginning of the case, several omental adhesions were found at the site of his prior splenic injury (Figure 2(a)). During adhesion take-down, extensive splenosis was noted around the spleen, left paracolic gutter, anterior peritoneum, and the mesentery (Figures 2(b) and 2(c)).
(a) Full-body tagged red blood cell scan approximately thirty minutes following injection of technetium 99 m red blood cells intravenously. Multiple foci at the splenic hilum (red circle). (b) Zoomed-in coronal view of sites of ectopic splenosis (red arrows). (c) Left sagittal view of multiple foci of splenosis posterior to spleen (red arrows).
CRIHEM2023-9714457.003.jpg
PMC10307128_02_CRIHEM2023-9714457.003.jpg
fig3
Subsequent CT imaging with Tc-99m-DRBC corroborated the laparoscopic findings, with multiple intra-abdominal foci of splenic implants observed (Figure 3(a)-3(c)).
Platelet count trend throughout the patient's clinical course. Brackets correspond to therapeutic interventions for ITP as labeled below the chart.
CRIHEM2023-9714457.004.jpg
PMC10307128_02_CRIHEM2023-9714457.004.jpg
fig4
At a 2-month postdischarge follow-up in the hematology clinic, the patient was asymptomatic with a stable platelet count of 612 x 103/muL.  Figure 4 depicts his platelet count trend throughout his clinical course.