PMC6664162_01
Ultrasonography of the abdomen showing a heterogeneous mass within the right abdominal cavity.
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We proceeded with an abdominal ultrasonography, revealing a heterogeneous mass within the right abdominal cavity and absence of the spleen in its normal position (Fig. 1).
(A): Axial view of the abdominal non-contrasted CT scan showing a suspicious pedicle (green arrow) and an ectopic spleen (red arrow) in the right abdominal and pelvic cavities. (B): Axial view of the abdominal contrasted CT scan showing a twisted splenic vascular pedicle (green arrow) in a whirlpool disposition. (C): Axial view of the abdominal contrasted CT scan showing an enlarged ectopic spleen (red arrow) extending from the right abdominal cavity to the pelvic cavity, lateral to the urinary bladder (blue arrow).
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Thus, a contrast-enhanced computed tomographic (CT) scan of the abdomen was ordered, revealing a 12.4 cm x 3.5 cm x 7.4 cm ectopic spleen in the abdominal cavity occupying the right lumbar, iliac, and pelvic regions (Fig. 2).
Volume-rendered technique CT abdominal angiography showing an anticlockwise torsion of the elongated splenic vascular pedicle in a whirlpool disposition.
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Subsequently, an abdominal CT angiography was performed, which demonstrated anticlockwise torsion of the elongated splenic vascular pedicle in a whirlpool disposition with splenic infarction characteristics (Fig. 3).
Image from video records made during laparoscopy revealing the absence of the spleen in its normal position in the left hypochondrium.
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Intra-operatively, the enlarged spleen was found in the right iliac fossa, displaced from the left hypochondrium (Fig. 4).
Image from video records made during laparoscopy revealing a non-viable spleen after adhesiolysis and detorsion in the right iliac fossa.
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After adhesiolysis and detorsion, the spleen was deemed non-viable (Fig. 5).