What is the most common anomaly of splenic embryology?

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The Most Common Anomaly of Splenic Embryology

The accessory spleen is the most common anomaly of splenic embryology, occurring in approximately 15% of patients. 1

Characteristics of Accessory Spleens

  • Accessory spleens are additional splenic tissue separate from the main spleen that develop during embryological formation 1
  • They are typically identified incidentally during routine splenectomy procedures 1
  • They represent a failure of complete fusion of splenic tissue during embryological development 1
  • Most commonly located near the splenic hilum and along the splenic vessels, but can also be found in the pancreatic tail, greater omentum, mesentery, and pelvis 1

Clinical Significance

  • In patients undergoing splenectomy for hematological disorders, undetected accessory spleens can lead to disease recurrence 1
  • Approximately 12% of patients who fail splenectomy or experience disease relapse after splenectomy are found to have an accessory spleen 1
  • Accessory spleens can become clinically significant in certain conditions:
    • May cause recurrence of hematological disorders after splenectomy (e.g., immune thrombocytopenia, hereditary spherocytosis) 1
    • Can undergo torsion, infarction, or rupture, causing acute abdominal pain 1
    • May be mistaken for lymphadenopathy or neoplastic lesions on imaging 1

Diagnosis

  • Accessory spleens can be detected through various imaging modalities:
    • CT scan with contrast enhancement (appears as small, round, homogeneous masses with enhancement patterns similar to the main spleen) 1
    • Nuclear medicine studies using technetium-99m sulfur colloid or heat-damaged red blood cells 1
    • Ultrasound with Doppler flow studies 1

Differentiation from Other Splenic Conditions

  • Accessory spleens should be differentiated from:
    • Splenic pseudocysts (acquired condition resulting from trauma, infection, or pancreatitis) 1
    • Hypersplenism (functional disorder with exaggerated splenic activity) 1
    • Splenomegaly (enlargement of the normal spleen due to pathological conditions) 1

Management Considerations

  • Asymptomatic accessory spleens generally require no treatment 1
  • For patients undergoing splenectomy for hematological disorders, careful identification and removal of accessory spleens is crucial to prevent disease recurrence 1
  • In cases of symptomatic accessory spleens (torsion, infarction), surgical removal may be indicated 1

References

1
Guideline

Accessory Spleen Anomalies

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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