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Introducción. Los quistes esplénicos son entidades anatómicas y clínicas poco frecuentes, con una incidencia aproximada de 0,07 %. Se clasifican como quistes esplénicos primarios, que contienen revestimiento epitelial y se subdividen en parasitarios y no parasitarios según su etiología, y quistes secundarios, que no poseen revestimiento epitelial en la luz quística y suelen ser el resultado de un traumatismo abdominal. Por lo general, son asintomáticos y se pueden encontrar de manera incidental durante estudios de imagen o en cirugía. Los síntomas están relacionados con el tamaño de los quistes. El tratamiento ideal es la resección quirúrgica, que puede ser total o parcial. Caso clínico. Paciente femenina de 23 años, sin antecedentes de trauma, con dolor abdominal intermitente, de varios meses de evolución. En los estudios imagenológicos se identificó un pseudoquiste esplénico gigante. Fue tratada mediante esplenectomía total por laparoscopia, sin complicaciones quirúrgicas. Resultados. Tuvo una adecuada evolución postoperatoria. Conclusión.El diagnóstico de quiste esplénico se realiza mediante estudios imagenológicos y se confirma con el análisis histopatológico. La esplenectomía total ha sido el tratamiento tradicional; sin embargo, ahora mediante la implementación de abordajes mínimamente invasivos, se prefiere la esplenectomía parcial, con el fin de preservar tejido esplénico y su función inmunológica.

Introduction.Splenic cysts are rare anatomical and clinical entities, with an approximate incidence of 0.07%. They are classified as primary splenic cysts, which contain epithelial lining and are subdivided into parasitic and non-parasitic depending on their etiology, and the secondary splenic cysts, which do not have an epithelial lining in the cystic lumen and are usually the result of abdominal trauma. They are usually asymptomatic and can be found incidentally during imaging studies or in surgery. The symptoms are related to the size of the cysts. The ideal treatment is surgical resection, which can be total or partial. Clinical case. A 23-year-old female patient, with no history of trauma, with intermittent abdominal pain, lasting several months. Imaging studies identified a giant splenic pseudocyst. She was treated by total laparoscopic splenectomy, without surgical complications. Results. She had an adequate postoperative evolution. Conclusion. The diagnosis of splenic cyst is made through imaging studies and confirmed with histopathological analysis. Total splenectomy has been the traditional treatment; however, now through the implementation of minimally invasive approaches, partial splenectomy is preferred, in order to preserve splenic tissue and its immunological function.

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Background: Hemophagocytic syndrome or hemophagocytic lymphohistiocytosis (HL) is an immune hyperactivation of multifactorial etiology, characterized by excessive activation of lymphocytes and macrophages, as well as numerous pro-inflammatory cytokines. It has a non-specific and highly variable clinical presentation, with splenomegaly being one of the clinical manifestations. Due to its nature, it can manifest during childhood or adult life, which is why it is a disease of diagnostic and therapeutic complexity. Clinical case: 38-year-old male patient without comorbidities, who presented with abdominal pain, choluria, fever > 38 °C and diaphoresis of more than 10 days of evolution. A bone marrow aspirate was performed as part of the diagnostic approach with data compatible with hemophagocytosis and cytopenias. The immunosuppressive management did not show the expected response, which is why an open splenectomy was performed as the last therapeutic option with adequate hematological control. A documentary review of the disease was carried out, and of the therapeutic options, emphasizing surgical management in case of refractoriness to medical treatment. Conclusions: Splenectomy increases the overall survival rate and the time free of HL progression, even though there are still no studies to determine with certainty the ideal time to perform a splenectomy in patients with pancytopenia without splenomegaly who suffer from hemophagocytic syndrome.

Introducción: el síndrome hemofagocítico o linfohistiocitosis hemofagocítica (LH) es una hiperactivación inmune de etiología multifactorial, caracterizada por activación excesiva de linfocitos y macrófagos, así como por numerosas citocinas proinflamatorias. Tiene una presentación clínica poco específica y muy variable, y la esplenomegalia es una de las manifestaciones clínicas. Debido a su naturaleza puede manifestarse durante la infancia o la vida adulta, por lo que es una enfermedad de complejidad diagnóstica y terapéutica. Caso clínico: paciente del sexo masculino de 38 años sin comorbilidades, quien presentó dolor abdominal, coluria, fiebre > 38 °C y diaforesis de más de 10 días de evolución. Se le hizo aspirado de médula ósea como parte del abordaje diagnóstico con datos compatibles con hemofagocitosis y citopenias. El manejo inmunosupresor no mostró la respuesta esperada, por lo que se hizo esplenectomía abierta como última opción terapéutica con adecuado control hematológico. Se hizo una revisión documental de la enfermedad y de las opciones terapéuticas con énfasis en el manejo quirúrgico en caso de refractariedad al tratamiento médico. Conclusiones: la esplenectomía aumenta la tasa de supervivencia general y el tiempo libre de progresión de la LH, aunque no hay todavía estudios para determinar con certeza el tiempo ideal para hacer una esplenectomía en pacientes con pancitopenia sin esplenomegalia que padezcan síndrome hemofagocítico.

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Introducción. El esplenúnculo se ha descrito con una incidencia global del 10 al 30 %. Puede ser una entidad de origen congénito o adquirida, frecuentemente está asociada a trauma abdominal o antecedente de esplenectomía por diversas causas. Caso clínico. Mujer en edad media, con antecedente de trauma abdominal y esplenectomía por ruptura traumática, quien 30 años después presenta un cuadro de dolor abdominal. Los estudios imagenológicos identificaron una masa sólida intrapancreática. Resultados. Fue llevada a pancreatectomía distal. Los hallazgos histológicos e inmunohistoquímicos confirmaron que la masa pancreática correspondía a un esplenúnculo intrapancreático adquirido, asociado al evento traumático previo. Conclusión. Los esplenúnculos suelen constituir un "incidentaloma". Los estudios imagenológicos se encuentran limitados, pues la tomografía computarizada, la resonancia nuclear magnética y la ultrasonografía presentan características imagenológicas similares con los tumores pancreáticos hipervascularizados, por lo que se debe practicar el estudio histopatológico durante su valoración. Esta entidad se debe incluir dentro de los diagnósticos diferenciales, con mayor énfasis en aquellos pacientes con historia de trauma abdominal y esplenectomía asociada, un escenario en el que esta lesión puede simular una neoplasia sólida del páncreas, con características malignas.

Introduction. Splenunculus has been described with an overall incidence of 10 to 30%. It can be an entity of congenital or acquired origin, it is frequently associated with abdominal trauma or a history of splenectomy for various reasons. Clinical case. Middle-aged woman, with a history of abdominal trauma and splenectomy due to traumatic rupture, who 30 years later presents with abdominal pain. Imaging studies identified a solid intrapancreatic mass. Results. She was taken to OR for distal pancreatectomy. The histological and immunohistochemical findings confirmed that the pancreatic mass corresponded to an acquired intrapancreatic splenunculus, associated with the previous traumatic event. Conclusion. Splenuncles usually constitute an "incidentaloma". Imaging studies are limited, since computed tomography, magnetic resonance imaging, and ultrasonography present similar imaging characteristics with hypervascularized pancreatic tumors, so histopathological study must be included during their evaluation. This entity should be included in the differential diagnoses, with greater emphasis on those patients with a history of abdominal trauma and associated splenectomy, a scenario in which this lesion can simulate a solid neoplasm of the pancreas, with malignant characteristics.

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El embarazo, especialmente el tercer trimestre, incrementa notablemente el riesgo de rotura de los aneurismas esplénicos. Cuando esto ocurre, se desencadena un cuadro clínico grave manifestado principalmente como un dolor abdominal agudo acompañado de inestabilidad hemodinámica. A pesar de la gran morbimortalidad tanto materna como fetal que esto conlleva, no existe hoy en día consenso sobre su manejo óptimo. Se presenta el caso de una secundigesta a la que se diagnostica de manera incidental un aneurisma en la arteria esplénica durante el segundo trimestre de gestación. Tras confirmarse dicho diagnóstico mediante resonancia magnética, se decide realizar una esplenectomía programada vía laparotómica en semana 24+2. La evolución maternofetal posterior fue favorable hasta la semana 40 en la que se produjo un parto eutócico. Los aneurismas esplénicos deben tratarse en todas las gestantes, independientemente de su tamaño o sintomatología, pues el beneficio supera los riesgos que supone una cirugía programada.

Pregnancy, especially the third trimester, significantly increases the risk of splenic aneurysm rupture. When this occurs, it results in a severe clinical presentation primarily characterized by acute abdominal pain accompanied by hemodynamic instability. Despite the substantial maternal and fetal morbidity and mortality associated with this condition, there is currently no consensus on its optimal management. We present the case of a second-time pregnant woman who incidentally received a diagnosis of a splenic artery aneurysm during the second trimester of gestation. After confirming this diagnosis through magnetic resonance imaging, it was decided to perform a scheduled laparotomic splenectomy at 24+2 weeks of gestation. Subsequent maternal and fetal evolution was favorable until the 40th week when a eutocic delivery occurred. Splenic aneurysms should be treated in all pregnant women, regardless of their size or symptomatology, as the benefits outweigh the risks associated with elective surgery.

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RESUMEN La hidatidosis es una parasitosis endémica en la Argentina. Los órganos más afectados son hígado y pulmón, pero la afectación esplénica única es infrecuente. El objetivo del trabajo es presentar 2 casos de hidatidosis esplénica única. Su diagnóstico presuntivo se realizó mediante el antecedente epidemiológico y los estudios por imágenes. Las serologías resultaron negativas en ambos casos. El tratamiento fue quirúrgico: se realizó esplenectomía laparoscópica total. Esta patología debe sospecharse en zonas endémicas ante la aparición de quistes esplénicos a pesar de presentar serologías negativas. La esplenectomía total evita la recidiva local y cavidades residuales; se prefiere el abordaje laparoscópico al disminuir la estadía hospitalaria y las complicaciones de la pared abdominal.

ABSTRACT Hydatid disease is an endemic parasitosis in Argentina. The liver and lungs are the organs more commonly affected, but isolated splenic involvement is rare. The aim of this study is to report two cases of isolated splenic hydatid disease. The diagnosis was suspected by epidemiology and imaging tests. The serologic tests were negative in both cases. Surgical management was decided and both patients underwent laparoscopic total splenectomy. This disease should be suspected in endemic areas in the presence of splenic cysts despite negative serologic tests. Total splenectomy prevents local recurrence and complications associated with the residual cavity. The laparoscopic approach is preferred as it results in a shorter length of hospital stay and fewer abdominal wall complications.

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BACKGROUND: Splenic abscess is a serious complication associated with infective endocarditis. There is still contradicting evidence regarding the optimal treatment pathway including timing of valve intervention and the approach for managing splenic foci. CASE PRESENTATION: We present a case of a hybrid staged approach in which we successfully performed a laparoscopic splenectomy following percutaneous abscess drainage and a delayed aortic valve replacement. CONCLUSIONS: A multidisciplinary teamwork is fundamental in providing optimal care for patients with distant complications associated with infective endocarditis. Our hybrid approach seems safe and feasible.

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Presentación del caso. Se trata de una mujer de 26 años que presentó dolor en epigastrio e hipocondrio izquierdo, con aumento del perímetro abdominal y pérdida de 5 kg de peso corporal. En el examen físico se detectó una masa de gran tamaño en el epigastrio, con bordes regulares, ligeramente dolorosa al tacto y no móvil. Los estudios de imagen revelaron una neoplasia mixta en el cuerpo y cola pancreática. Intervención terapéutica. Se practicó una esplenopancreatectomía corpo-caudal, con extirpación completa del tumor. Evolución clínica. La paciente recibió cuidados especializados y vigilancia estrecha posquirúrgica en la unidad de cuidados intensivos, sin presentar complicaciones relevantes. Tras el alta hospitalaria, la paciente refirió un buen estado general en los controles de seguimiento, que incluyeron una tomografía realizada a los 12 meses, donde no se evidenciaron restos o recidivas tumorales

Case presentation. A 26-year-old woman who presented with pain in the epigastrium and left hypochondrium, with increased abdominal perimeter and loss of 5 kg of body weight. Physical examination revealed a large mass in the epigastrium, with regular borders, slightly painful to the touch and non-mobile. Imaging studies revealed a mixed neoplasm in the pancreatic body and tail. Treatment. A corpo-caudal splenopancreatectomy was performed, with complete removal of the tumor. Outcome. The patient received specialized care and close postoperative surveillance in the intensive care unit, with no relevant complications. After hospital discharge, the patient reported a good general condition in the follow-up controls, which included a computed tomography scan performed after 12 months, where no tumor remnants or recurrences were evidenced

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ABSTRACT Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention.

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SUMMARY OBJECTIVE: Several studies have investigated the correlation between the effects of different surgical treatments and laboratory exams for schistosomal portal hypertension, especially concerning portal system thrombosis. The etiopathogenic factors of this thrombosis are not fully understood. In this study, the correlation between surgical treatment for schistosomal portal hypertension and the occurrence of postoperative portal system thrombosis was investigated. METHODS: A total of 61 patients who underwent surgical treatment for schistosomal portal hypertension were distributed into four groups: Patients in Group 1 (n=12) underwent portal variceal disconnection associated with splenic artery ligation and spleen preservation. Patients in Group 2 (n=20) underwent portal variceal disconnection and total splenectomy. Patients in Group 3 (n=20) underwent portal variceal disconnection with subtotal splenectomy, preserving the upper splenic pole supplied by the splenogastric vessels. Patients in Group 4 (n=9) underwent portal variceal disconnection with total splenectomy and autogenous splenic implants on the greater omentum. Late postoperative portal vein thrombosis was diagnosed using Doppler ultrasound. RESULTS: Over the 10-year follow-up, portal vein thrombosis occurred in 26 operated patients (42.6%), with no significant difference observed among the four surgical groups (p=0.217). Most of the thrombi only partially occluded the portal system veins. All the patients presented with a thrombus inside the portal vein. There was no difference in hematological and biochemical tests between groups with or without portal vein thrombosis. CONCLUSIONS: Portal vein thrombosis is often observed in the late postoperative period, irrespective of the surgical treatment employed, and is not associated with patient characteristics or any hematological and biochemical tests.

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True splenic artery aneurysms are exceedingly rare and the medical literature contains only a limited number of reports on this pathology. Presently, there remains a lack of consensus regarding the optimal management and treatment approaches for patients in this category. Over the course of the last century, significant changes have occurred in the realm of surgical options, transitioning from open and endovascular procedures to the more advanced laparoscopic and robotic interventions. The propensity for these aneurysms to rupture underscores the need for timely intervention. The risk of rupture is notably elevated in patients harboring giant splenic artery aneurysms. In this report, we present the case of a 55-year-old woman diagnosed with a giant splenic artery aneurysm measuring 12x12 cm in diameter. She presented with notable weakness, discomfort, and pain in the left subcostal area. In response to her complaints and after thorough evaluation, we opted for a surgical procedure encompassing distal pancreatic resection in conjunction with splenectomy and resection of the giant splenic artery aneurysm.

Os aneurismas verdadeiros da artéria esplênica são extremamente raros, e há um número limitado de relatos sobre essa condição na literatura médica. Atualmente, não há consenso sobre as abordagens ideais de manejo e tratamento para pacientes que se enquadram nessa categoria. Ao longo do século passado, ocorreram mudanças significativas no domínio das opções cirúrgicas, passando de procedimentos abertos e endovasculares para intervenções laparoscópicas e robóticas mais avançadas. A propensão à ruptura do aneurisma ressalta a necessidade de intervenção em tempo oportuno. O risco de ruptura é notavelmente elevado em pacientes com aneurismas gigantes da artéria esplênica. Neste relato, apresentamos o caso de uma mulher de 55 anos diagnosticada com aneurisma gigante de artéria esplênica medindo 12x12 cm de diâmetro. A paciente apresentava fraqueza notável, desconforto e dor na região subcostal esquerda. Em resposta às suas queixas e após avaliação minuciosa, optamos por um procedimento cirúrgico que incluiu pancreatectomia distal associada a esplenectomia e ressecção do aneurisma gigante da artéria esplênica.

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Los quistes esplénicos son infrecuentes y presentan una baja incidencia (0.07%). Las etiologías son varias, pero en su mayoría se deben a parasitarios y no parasitarios. Entre los primeros se encuentran los quistes hidatídicos por equinococosis que son más comunes sobre todo en zonas endémicas. En el siguiente trabajo se presenta el caso de una paciente de sexo femenino de 17 años de edad que consulta por un cuadro de 6 días de evolución que inicia con dolor, tipo puntada de moderada intensidad, localizado en hipocondrio izquierdo, acompañado de fiebre graduada en 38 grados con escalofríos.

Splenic cysts are uncommon and have a low incidence rate (0.07%). The etiologies are diverse, but mostly attributed to both parasitic and non-parasitic origins. Among the former, hydatid cysts due to echinococcosis are more prevalent, especially in endemic areas. This report describes the case of a 17-year-old female patient who presented with a 6-day history of pain, of moderate intensity and stabbing type, localized in the left hypochondrium. The pain was accompanied by a fever reaching 38 degrees Celsius and chills.

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BACKGROUND: Treatment of splenic trauma is currently based on non-surgical treatment or the use of interventional radiology. The conservative surgery of the spleen in splenic trauma remains marginal. OBJECTIVE: To analyze the safety and efficacy of conservative surgical treatment in splenic trauma. METHOD: A retrospective study was performed over a 16-year period with the intention of recording the diagnostic and therapeutic attitude in a second level hospital, focusing on patients who received conservative splenic surgical treatment for splenic trauma, excluding splenectomies and non-surgical treatment. RESULTS: 110 patients presented splenic trauma. Spleen-sparing surgery was performed in 15 patients. The grades of splenic lesions were: 1 patient with grade I, 1 patient with grade II, 7 patients with grade III and 6 patients with grade IV. Surgical treatment was splenorrhaphy in 5 patients (33%), hemostatic agents and polyglycolic acid mesh in 4 (26%), partial splenectomy with placement of polyglycolic acid mesh in 3 (20%), partial splenectomy in 2 (13%), and electrocautery in 1 (6%). None of the patients initially treated with conservative surgery required posterior splenectomy and no patient died. CONCLUSION: We provide evidence supporting the usefulness and safety of conservative splenic surgery in splenic trauma, which would have its place in grades II, III and IV trauma in health centers that do not have urgent interventional radiology.

ANTECEDENTES: El tratamiento del traumatismo esplénico se basa en medidas conservadoras no quirúrgicas o en el uso de radiología intervencionista. La cirugía conservadora del bazo en el traumatismo esplénico sigue siendo inusual. OBJETIVO: El análisis de seguridad y eficacia del tratamiento quirurgico conservador en el traumatismo esplénico. MÉTODO: Se realizó un estudio retrospectivo durante un período de 16 años con la intención de registrar la actitud diagnóstica y terapéutica en un hospital de segundo nivel, enfocándose en los pacientes que recibieron tratamiento quirúrgico conservador esplénico por traumatismo esplénico, excluyendo esplenectomías y tratamientos no quirúrgicos. RESULTADOS: 110 pacientes presentaron traumatismo esplénico. La cirugía conservadora esplénica se realizó en 15 pacientes. Los grados de lesiones esplénicas fueron: 1 paciente con grado I, 1 paciente con grado II, 7 pacientes con grado III y 6 pacientes con grado IV. El tratamiento quirúrgico fue esplenorrafia en 5 pacientes (33%), agentes hemostáticos y malla de ácido poliglicólico en 4 (26%), esplenectomía parcial con colocación de malla de ácido poliglicólico en 3 (20%), esplenectomía parcial en 2 (13%) y hemostasia con electrocauterio en 1 (6%). Ninguno de los pacientes tratados inicialmente con cirugía conservadora requirió esplenectomía posterior y ningún paciente falleció. CONCLUSIONES: La cirugía conservadora esplénica puede ser útil y segura en traumatismos esplénicos, la cual tendría su lugar en traumatismos de grados II, III y IV en centros hospitalarios en los que no se cuente con radiología intervencionista urgente.

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Introducción: El bazo es el órgano más afectado en el traumatismo cerrado de abdomen en el adulto. El traumatismo esplénico puede ser por lesiones no penetrantes (cerrado) o por lesiones penetrantes. Las pruebas de imagen más útiles a la hora de evaluar el trauma esplénico son la ecografía de evaluación enfocada para traumatismo (FATS, por sus siglas en inglés) y la tomografía computarizada (TC). Objetivo: describir el manejo del traumatismo esplénico en el Hospital Nacional de Itauguá. Metodología: Se trata de un estudio observacional, descriptivo de serie de casos en el cual se incluyó a pacientes adultos con diagnóstico de traumatismo esplénico que fueron atendidos en la urgencia de adultos del Hospital Nacional de Itauguá entre enero de 2018 y enero de 2020. Se incluyó a la totalidad de los pacientes atendidos y no se excluyó a ninguno. Las variables que se estudiaron fueron sexo, edad, tipo de trauma, mecanismo de trauma, hemodinamia, imagenología (FATS y TC), grado de la lesión (I al V), cirugía de urgencias, cirugía realizada, tratamiento no operatorio, éxito del tratamiento, días de internación, óbito y lesiones asociadas. Resultados: Se presenta una serie de 10 casos, todos son del sexo masculino y cuya edad tiene una media de 30,7 ± 10,58 años. En todos los casos el trauma fue cerrado. El mecanismo del trauma fue accidente con motocicleta en el 80 %. En cuanto a la hemodinamia el 80 % estuvo estable, el 100 % se realizó la FACTS y el 80 % la TC. El grado más frecuente fue el grado IV con 40 %. Discusión: el manejo del trauma esplénico ha cambiado a lo largo del tiempo, actualmente se busca un manejo no quirúrgico, sin embargo, esto depende de las condiciones del paciente.

Introduction: The spleen is the most affected organ in blunt trauma to the abdomen in the adult. Splenic trauma can be due to non-penetrating (blunt) or penetrating injuries. The most useful imaging tests when evaluating splenic trauma are focused assessment sonography for trauma (FATS) and computed tomography (CT). Objective: to describe the management of splenic trauma at the Hospital Nacional de Itauguá. Methodology: this is an observational, descriptive case series study in which adult patients with a diagnosis of splenic trauma who were seen in the adult emergency department of the Hospital Nacional de Itauguá between January 2018 and January 2020 were included. All patients attended were included and none were excluded. The variables studied were sex, age, type of trauma, mechanism of trauma, hemodynamics, imaging (FATS and CT), grade of injury (I to V), emergency surgery, surgery performed, non-operative treatment, treatment success, days of hospitalization, death and associated injuries. Results: We present a series of 10 cases, all of them male, with a mean age of 30.7 ± 10.58 years. In all cases the trauma was blunt. The mechanism of trauma was motorcycle accident in 80 %. Regarding hemodynamics, 80% were stable, 100% underwent FACTS and 80% underwent CT. The most frequent grade was grade IV with 40%. Discussion: the management of splenic trauma has changed over time, currently non-surgical management is sought, however, this depends on the patient's conditions.

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Splenectomy remains an effective treatment for refractory immune cytopenia (RIC), which encompasses immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Accessory spleens (AS) have been described without identifying specific risk factors. We retrospectively analyzed patients with RIC after splenectomy who underwent splenic scintigraphy (SS) at our institution. Seventy-one patients were included. Sixty-two patients had ITP, five had AIHA, and four had Evans syndrome. Seventy-five percent (n = 53) were women. Eleven patients (15.5%) had an AS detected by SS. A complete response (CR) to first-line steroids (odds ratio (OR) 5.75, 95% confidence interval (CI) 1.37-24.14, p = 0.017) and the absence of Howell-Jolly bodies (HJB) in peripheral blood smear (PBS) (OR 11.37, 95% CI 2.70-47.85, p = 0.001) were found to be risk factors. Patients with both elements had a higher rate of AS (83.3%) when compared to those with one or no factors (p < 0.001). Eight patients (73%) underwent an accessory splenectomy: seven (87.5%) achieved a CR, and none had perioperative complications. The presence of HJB in PBS changed from 25 to 87.5% after accessory splenectomy. We recommend the search for an AS via SS in patients with RIC due to ITP, who had a CR to corticosteroids and the absence of HJB in PBS. Accessory splenectomy is a safe and effective procedure.

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Splenosis is defined as viable splenic tissue that is autotransplanted into other compartments in the body. Intrahepatic splenosis is a rare diagnosis that can be difficult for clinicians to identify. The most common causes of splenosis include abdominal trauma and splenectomy. While most patients with intrahepatic splenosis are asymptomatic, in the presence of risk factors of hepatocellular carcinoma, it is paramount to rule out malignancy. In this report, we present a patient with imaging findings concerning for hepatocellular carcinoma, ultimately diagnosed with percutaneous biopsy and technetium-99m-tagged heat-damaged red blood cell scintigraphy-proven intrahepatic splenosis.

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Introducción: La colonoscopia es una herramienta básica en el estudio de patologías del área colorrectal, así como uno de los pilares del screening del cáncer de colon y recto. Sin embargo, no es un procedimiento exento de riesgos, algunos de ellos con elevada morbimortalidad. Caso Clínico: Varón de 55 años con enolismo crónico y hepatopatía por Virus Hepatitis C y Enfermedad Pulmonar Obstructiva Crónica. En estudio por diarrea se solicita una ecografía de abdomen donde, como único hallazgo, se muestra una lesión de 7 mm a nivel de páncreas y una colonoscopia con intención diagnóstica que no muestra alteraciones significativas. Con la sospecha de que la lesión pancreática pudiese ser la causa del cuadro diarreico, se realiza un escáner abdominal donde se muestra una colección subcapsular a nivel esplénico de 11 × 3 cm compatible con hematoma sin signos de sangrado activo. Dada la estabilidad hemodinámica, se inicia manejo conservador, con empeoramiento del dolor abdominal e hipotensión en las siguientes 12 h. Se repite prueba de imagen objetivando aumento de hematoma esplénico y líquido libre intraabdominal. Se indica cirugía urgente donde se evidencia hemoperitoneo secundario a lesión esplénica que obliga a realizar esplenectomía. Conclusión: La presencia de una posible lesión esplénica yatrogénica se debe tener en cuenta en el diagnóstico diferencial en un paciente con dolor abdominal de inicio agudo y anemización o alteración del estado hemodinámico dentro de las primeras 24-48 h tras la realización de una colonoscopia.

Introduction: Colonoscopy is a basic tool in the study of pathology of the colorectal area, as well as one of the pillars of colon and rectal cancer screening. However, it is not a risk-free procedure, some of them with high morbimortality. Case Report: 55-year-old male with chronic alcoholism and hepatopathy due to HCV, COPD. During a study for diarrhea, an ultrasound of the abdomen revealed a 7 mm pancreas tumor, and a diagnostic colonoscopy showed no significant alterations. With the suspicion that the pancreatic lesion could be the cause of the diarrhea, an abdominal scan was performed showing a subcapsular collection at the splenic level of 11 × 3 cm compatible with hematoma without signs of active bleeding. Due to the hemodynamic stability, conservative management was decided, with worsening abdominal pain and hypotension in the following 12 hours. A new imaging test showed an enlarged splenic hematoma and free abdominal fluid suggestive of hemoperitoneum. Urgent surgery found hemoperitoneum secondary to splenic lesion and splenectomy was required. Conclusion: The presence of a possible iatrogenic splenic lesion should be considered in the differential diagnosis in a patient with acute onset abdominal pain and anemia or hemodynamic status alteration within the first 24-48 hours after colonoscopy.

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Objetivo: Se presenta un caso de rotura esplénica atraumática. Caso Clínico: Mujer joven que estando ingresada y con reposo relativo por colección intraabdominal cercana a la colostomía presenta rotura de bazo. Se realiza esplenectomía urgente evidenciando gran hemoperitoneo y rotura esplénica. Discusión y conclusiones: El diagnóstico de rotura esplénica atraumática debe tenerse en cuenta en los pacientes con dolor abdominal de aparición súbita ya que un retraso en el diagnóstico puede conducir a un aumento de la tasa de mortalidad.

Objective: A case of idiopathic atraumatic splenic rupture is presented. Clinical case: A young woman was admitted to hospital with relative rest due to an intra-abdominal collection near the colostomy and presented with a ruptured spleen. An urgent splenectomy was performed, revealing large haemoperitoneum and splenic rupture. Discussion and conclusions: the diagnosis of atraumatic splenic rupture should be taken into account in patients with sudden onset abdominal pain, as a delay in diagnosis may lead to an increased mortality rate.

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Introducción. El bazo es un órgano linfoide implicado en el reconocimiento antigénico, la depuración de patógenos y la remoción de eritrocitos envejecidos o con inclusiones citoplasmáticas. La esplenectomía es una técnica utilizada tanto para el diagnóstico (linfomas), el tratamiento (trombocitopenia inmune, anemia hemolítica adquirida) y la curación (microesferocitosis hereditaria) de diversas enfermedades. Métodos. Describir los principales cambios hematológicos y complicaciones asociadas al procedimiento de esplenectomía. Discusión. Los cambios posteriores a la esplenectomía pueden ser inmediatos, como la aparición de cuerpos de Howell-Jolly, la trombocitosis y la presencia de leucocitosis durante las primeras dos semanas. Otras complicaciones tempranas incluyen la presencia de trombosis, en especial en pacientes con factores de riesgo secundarios (edad, sedentarismo, manejo hospitalario, obesidad) o un estado hipercoagulable (diabetes, cáncer, trombofilia primaria), siendo tanto el flujo de la vena porta como el volumen esplénico los principales factores de riesgo para su aparición. Las complicaciones tardías incluyen la alteración en la respuesta inmune, aumentando el riesgo de infecciones por bacterias encapsuladas, en conjunto con una reducción en los niveles de IgM secundario a la ausencia de linfocitos B a nivel de bazo. Debido al riesgo de infecciones, principalmente por Streptococcus pneumoniae, la esplenectomía parcial se ha considerado una opción. Conclusión. Una adecuada valoración de la indicación de esplenectomía y la identificación precoz de complicaciones posoperatorias son fundamentales para reducir la mortalidad asociada a la esplenectomía

Introduction. The spleen is a lymphoid organ involved in antigen recognition, pathogen clearance, and removal of aged erythrocytes or those with cytoplasmic inclusions. Splenectomy is a technique used for diagnosis (lymphomas), treatment (immune thrombocytopenia, acquired hemolytic anemia), and cure (hereditary microspherocytosis) of various diseases. Methods. To describe the main hematological changes and complications associated with the splenectomy procedure. Discussion. Changes after splenectomy can be considered immediate: the appearance of Howell-Jolly bodies, thrombocytosis, and leukocytosis during the first two weeks. Other complications include the presence of thrombosis, especially in patients with risk factors (age, sedentary lifestyle, long hospital stay, obesity) or a hypercoagulable state (diabetes, cancer, primary thrombophilia), with both portal vein flow and splenic volume being the main risk factors for its appearance. Late complications include altered immune response, increased risk of infections by encapsulated bacteria, and a reduction in IgM levels secondary to the absence of B lymphocytes in the spleen; due to the risk of diseases mainly by Streptococcus pneumoniae, partial splenectomy has been considered an option. Conclusion. An adequate assessment of the indication for splenectomy and the early identification of complications are essential to reduce the mortality associated with splenectomy

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Se describe el caso clínico de un adulto joven de 30 años de edad, con antecedente de buena salud, quien fue asistido en el Servicio de Cirugía del Hospital Universitario Manuel Ascunce Domenech en Camagüey por presentar aumento de volumen en la región abdominal de dos meses de evolución, concomitante con astenia, anorexia, vómitos y pérdida de peso. En el examen físico resultaron notables el abdomen globuloso (bazo palpable) sin dolor, un hematoma periumbilical y múltiples adenopatías supraclaviculares; en tanto, en los estudios imagenológicos se evidenció la presencia de esplenomegalia. Se realizó esplenectomía con administración de anestesia general endotraqueal y en el estudio histopatológico de la muestra resecada se confirmó el diagnóstico de linfoma primario del bazo.

The case report of a 30-year-old young adult with a history of good health is described, who was assisted at the Surgery Service of Manuel Ascunce Domenech University Hospital in Camagüey due to volume increase in the abdominal region with a course of two months, concomitant with asthenia, anorexia, vomits and weight loss. Physical examination revealed a globular abdomen (palpable spleen) with no pain, a periumbilical hematoma, and multiple supraclavicular adenopathies; meanwhile, in the imaging studies splenomegaly was evidenced. Splenectomy was performed with administration of general endotracheal anesthesia and the histopathological study of the resected sample confirmed the diagnosis of primary spleenic lymphoma.

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La Transformación Nodular Angiomatoide Esclerosante del bazo (SANT) es una patología poco común, que afecta a vasos sanguíneos de forma benigna con esclerosis extensa de la pulpa roja. Paciente masculino, 24 años, consulta en centro privado (Paraguay) por un cuadro de 7 meses de evolución de disnea paroxística y sudoración fría. Al examen físico y laboratorial sin datos de valor. La ecografía abdominal demuestra bazo con parénquima inhomogéneo con imagen pseudonodular 48x41 mm de diámetro, la RMN con contraste confirma hallazgo por nódulo irregular, con realce que predomina en la periferia de la fase arterial, con aspecto radiado y relleno centrípeto en fase venosa y tardía, la histopatología confirma diagnóstico clínico-imagenológico de SANT. Esta tumoración es frecuente entre los 45 a 48 años, manifestada con esplenomegalia, poca sintomatología, llama la atención la presentación del caso que se contrapone con la bibliografía. Considerando la falta de métodos auxiliares para descartar la malignidad, se aplica esplenectomía como conducta terapéutica.

Nodular Angiomatoid Sclerosing Transformation of the Spleen (SANT) is a rare pathology, which affects blood vessels benignly with extensive sclerosis of the red pulp. A 24-year-old man consulted in a private center (Paraguay) for a 7-month course of paroxysmal dyspnea and cold sweating. Physical examination and laboratory evaluation show no abnormalities. Abdominal ultrasound shows a spleen with heterogeneous parenchyma and a pseudonodular image that is 48mm x 41mm in diameter. Contrasted MRI confirms the finding of an irregular nodule, with enhancement that predominates in the periphery of the arterial phase, with radiated appearance and centripetal filling in venous and late phase. Histopathology confirms diagnosis of SANT. SANT is frequent between 45 and 48 years of age, manifested with splenomegaly and scarce symptomatology. The presentation of this case differs with literature. Considering the lack of auxiliary methods to rule out malignancy, a splenectomy is performed.

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