Additional share of a spleen
Additional share of a spleen — an extra splenic congestion of liyenalny fabric which has own blood supply, an innervation, the capsule and a serous cover. Usually proceeds asymptomatically. At the big sizes, intra organ localization, strengthening of functional activity it is shown by the dispepsichesky frustration, pain syndromes palpated by volume educations. It is diagnosed by means of a stsintigrafiya of a spleen, an angiography, ultrasonography of abdominal organs, a diagnostic laparoscopy. In the presence of clinical symptomatology additional shares are subject to surgical removal.
Additional share of a spleen
Additional spleen — one of frequent congenital malformations of body revealed at 11-16% of the patients passing researches on an occasion of diseases of an abdominal cavity and in 10-30% of cases of autopsies. Usually additional shares have the sizes from 4-5 to 25 mm, however examples of identification of knots to 10 cm are known. At 63% examined one additional spleen, at 20% — two, at 17% — from three and more is defined. The maximum known number of extra splenic liyenalny educations, disseminirovanny on an abdominal cavity, exceeds 400 microknots. Sometimes the congestion from several small spleens replaces the main body. In 75% of cases the additional share is localized in gate of a normal spleen, at 16% of patients — near a pancreas tail, more rare — in gastrosplenic, selezenochno-gastric, gastro, selezenochno-renal ligaments, along a splenic artery, in a small and big epiploon, a bryzheyka of a small intestine, duglasovy space at women, an appendage of a small egg and near the left yaichkovy artery at men, zabryushinny cellulose. In casuistic cases education ektopirovano in a pancreas, a usual spleen.
Reasons of an additional share of a spleen
Formation of extra splenic sites of liyenalny fabric is a dizontogenetichesky embriopatiya. The heredity role in developing of pathology is not proved. According to most of experts in the sphere of hematology, formation of additional segments has the same etiology, as other anomalies of development of a spleen. The reasons of defect can become possible:
- Adverse exogenous factors. The probability wrong development of a spleen of a fruit increases in the presence of continuous or single intensive physical and chemical impacts (ionizing radiation, alcohol, some pharmaceutical medicines, production poisons). The Teratogenny effect in the period of an embryogenesis is rendered by causative agents of a rubella, Cytomegaloviral infection, toxoplasmosis, herpes, etc.
- State of health and pregnant woman's diet. The increased risk of formation of an additional spleen is noted at the children born by women who have diabetes, a hypothyroidism, a diffusion toxic craw, heart diseases, arterial hypertension. As well as other dizontogenetichesky embriopatiya, anomaly meets at late pregnancy, deficiency of the main micronutrients and vitamins B a food allowance more often.
Two main mechanisms of formation of an additional share of a spleen are installed: violation of merge of certain sites of mesenchymal splenic weight in uniform body in dorsalny mezogastriya and multiple laying of elements of a mesenchyma of which the liyenalny parenchyma is formed. The embryogenesis is most often broken on 5-8 weeks of pre-natal development of a fruit when there is an active mitotic division of mesenchymal cages predecessors of a splenic pulp, their congestion, consolidation on the gonadny party of a dorsalny bryzheyka, germination by vessels, isolation in separate body. At influence of a teratogenny factor on 6-10 weeks of a gestation migration of an additional splenic share in the top part of a small egg is possible. Substantial increase of functional activity of an additional liyenalny parenchyma is clinically shown by a gipersplenizm.
Symptoms of an additional share of a spleen
At most of patients of any clinical manifestations it is not observed as very small sizes usually have pathological educations. At a large additional spleen there is a sdavleniye of nearby bodies, in that case the symptomatology depends on an arrangement of an abnormal share. Most often there are violations of work of a digestive tract: moderate pains of various localization, nausea, chronic locks. At a sdavleniye of bilious channels yellowing of skin and mucous membranes, pains in the right podreberye, darkening of urine and decolouration a calla can be observed. At men from an ektopiy additional spleen in a scrotum at a palpation the roundish education reminding a small egg is defined. The general condition of patients is usually not broken.
At the sizes of an additional share more than 5 cm are possible development of intestinal impassability with a delay of a chair and gases, sharp belly-aches, repeated vomiting. The additional spleen constitutes danger to patients with pathologies of system of blood (autoimmune trombotsitopenichesky purpury, hereditary hemolytic anemia). At such patients the risk of a recurrence of a disease even after the carried-out splenektomiya remains. It is sometimes observed an abnormal share with the subsequent necrosis of a spleen at which involvement in process of a peritoneum or formation of solderings is possible.
Diagnosis is complicated as in most cases the disease proceeds asymptomatically. The additional share of a spleen often becomes a casual find when carrying out inspection of the patient concerning other pathological states. It is necessary to suspect a disease at patients with chronic dispepsichesky complaints of not clear genesis. The most informative methods of diagnostics are:
- Radio nuclide stsintigrafiya of a spleen. Introduction marked radioactive medicine of the elements of blood which are previously subjected to thermal treatment is followed by their accumulation in a liyenalny parenchyma that manages to be visualized on the monitor. The method has nearly 100% sensitivity and specificity. If necessary it is supplemented with an angiography.
- Ultrasonography of an abdominal cavity. The simple noninvasive research helps to find additional shares if they have the sufficient sizes and are not covered with other abdominal bodies. In difficult diagnostic cases KT with intravenous administration of contrast substance which allows to reveal even small additional educations is in addition appointed.
- Diagnostic laparoscopy. The method is applied at difficulties in diagnosis. Introduction of a laparoskop to an abdominal cavity gives to the surgeon the chance to estimate a condition of internals and to find an additional spleen. Advantages of a research are sensitivity and low-invasiveness, cuts (to 1 cm) quickly begin to live without formation of hems.
In clinical blood test thrombocytopenia, hyper regenerator anemia, considerable erythrocytes, confirming development of a gipersplenizm can be observed. At the expressed changes of peripheral blood the marrow puncture for the subsequent cytologic research is recommended. At suspicion on violation of passability of intestines carry out the roentgenogram of an abdominal cavity.
Differential diagnostics of an additional share of a spleen is carried out with a polisplenichesky syndrome at a dekstropozition of internals, a postsplenektomichesky splenoz, inflammatory diseases of intestines, mechanical jaundice, functional dyspepsia, sharp intestinal impassability, malignant new growths of system of blood formation, limfoproliferativny diseases, tumors and cysts of a pancreas, adrenal glands, violations of the curtailing system of blood. Except survey of the hematologist and the gastroenterologist consultation of the oncologist, an onkogematolog, the infectiologist, immunologist, hepatologist, endocrinologist, abdominal surgeon can be required by the patient.
Treatment of an additional share of a spleen
Dynamic observation at the gastroenterologist and the hematologist with performing planned diagnostics is recommended each 6-12 months to patients without symptoms of a gipersplenizm, a perekrut of a vascular leg, a sdavleniye of surrounding bodies. Main objectives of monitoring are control of the amount of additional educations and timely identification of indirect signs of increase in activity of a splenic parenchyma. In the presence of clinically expressed symptomatology expeditious treatment is shown:
- Removal of an additional spleen. One of additional shares is removed when because of its big sizes or localization in a pancreas, an appendage of a small egg, other bodies it breaks their functioning, causes a resistant pain syndrome. Operation will most often be executed by a laparoscopic method, at an intra organ arrangement of an additional segment carrying out interventions by laparotomichesky or other access is possible.
- Total removal of splenic fabric. Before implementation of a splenektomiya for not traumatic reasons careful inspection is necessary for identification of asymptomatic additional spleens. At detection of anomaly is removed as body, and nitelny liyenalny educations. Such radical approach is caused by a possible recurrence of hemolytic anemia, Verlgof's disease because of compensatory activation of additional fabric.
Forecast and prevention
Existence of an additional share does not cause discomfort during all life in many patients. Forecast of a disease favorable. Specific prevention does not exist. For the warning of development of complications to patients with this anomaly it is regularly necessary to make clinical blood test, once a year to undergo ultrasound examination of an abdominal cavity for dynamic assessment of the sizes and structure of an additional spleen. It is necessary to watch carefully a condition of a GIT and to address the expert in the sphere of gastroenterology at emergence of any dispepsichesky frustration.