Page 43 - Journal of Laparoscopic Surgery - WALS Journal

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10.5005/jp-journals-10033-1269
Proximal Small Intestinal Obstruction: A Rare Presentation of Splenosis
CASE REPORT

Proximal Small Intestinal Obstruction:

A Rare Presentation of Splenosis

2
1 Vijaykumar C Bada, Rajvilas Anil Narkhede

ABSTRACT the periumbilical region. Bowel sounds were sluggish.
Splenosis is a benign condition caused by heterotrophic There was no evidence of any free fluid or palpable mass
autotransplantation of splenic pulp following splenic trauma in the abdomen.
or surgery. Splenosis is rare and intestinal obstruction due to Contrast-enhanced computed tomography of the
splenosis is even rarer. Most of the patients with splenosis are abdomen showed dilated proximal bowel loops with
asymptomatic. There are few reports of large bowel obstruction
due to splenosis, but reports of small bowel obstruction due dilated duodenum and stomach (Fig. 1). Multiple
to splenosis are scanty. We report a case of proximal small hyperdense lesions were noted in the peritoneal cavity,
bowel obstruction due to postsplenectomy splenosis treated compressing proximal jejunum with dilated proximal
by laparoscopic surgery. Index of suspicion with radiological jejunum, duodenum, and stomach with collapsed distal
evaluation is the key to preoperative diagnosis of splenosis.
Laparoscopic surgery is an effective means of treating such bowel.
patients with good long-term outcome. Diagnostic laparoscopy showed omento-parietal
adhesions, proximal dilated bowel loops, narrowing in
Keywords: Intestinal obstruction, Postsplenectomy complica-
tions, Splenosis. the proximal part of jejunum with multiple splenunculi
at the area of transition (Fig. 2). Distal small bowel was
How to cite this article: Bada VC, Narkhede RA. Proximal
Small Intestinal Obstruction: A Rare Presentation of Splenosis. collapsed. Adhesiolysis, resection of the strictured jejunal
World J Lap Surg 2016;9(1):41-43. part with the compressing splenunculi, and end-to-end
anastomosis were done. Postoperative recovery was
Source of support: Nil
uneventful. He was discharged on postoperative day 5.
Conflict of interest: None On follow-up up to 1 year, he was comfortable with no
recurrence in pain or vomiting.
CASE REPORT
We present the case of a 55-year-old male who DISCUSSION
presented with acute colicky, nonradiating pain in the We reported the case of an uncommon presentation of
umbilical region, gradually increasing in intensity splenosis. Very few cases of small bowel obstruction
since 15 days and associated with multiple episodes of secondary to splenosis are reported, but proximal small
nonprojectile, nonbilious vomiting, 3 to 4 times a day, bowel obstruction is still rare. Rectosigmoid and small
which used to relieve the pain. He had constipation since bowel obstruction due to splenunculi has been reported
3 days associated with gradually increasing abdominal by Gincu et al and Sirinek et al. High index of suspicion
1,2
1
distension. He had similar episodes of abdominal
pain and multiple bilious vomiting since last 5 years,
which were treated conservatively. He had a history
of blunt abdominal trauma 40 years back for which
laparotomy was performed for hemoperitoneum, details
of which were not available. History of loss of weight
is also present. On examination, he had tachycardia.
Abdomen was distended with tenderness localized to

2
1 Consultant, Fellow
1,2 Department of Surgical Gastroenterology, Global Hospitals
Hyderabad, Telangana, India
Corresponding Author: Rajvilas Anil Narkhede, Fellow
Department of Surgical Gastroenterology, Global Hospitals
Hyderabad, Telangana, India, Phone: +918897389898, e-mail:
rajvilas.narkhede@gmail.com Fig. 1: Contrast-enhanced computed tomography of the abdomen
suggesting splenosis with transition point of intestinal obstruction
World Journal of Laparoscopic Surgery, January-April 2016;9(1):41-43 41