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Die Nebenmilz im Pankreasschwanz—eine vernachlässigte Entität?

Ein Beitrag zur Embryologie, Topographie und Pathologie der Ektopien des Milzgewebes

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Zusammenfassung

Nebenmilzen finden sich autoptisch in 10–15% der Bevölkerung, in 1–2% liegen sie im Pankreasschwanz. Folglich müssen sie in die Differenzialdiagnose intra- und peripankreaner tumoröser Läsionen einbezogen werden. Nach splenorenaler Fusion können sie pararenal-retroperitoneal zu finden sein, nach splenogonadaler Fusion mit den Gonaden ins Becken oder Skrotum deszendieren. Da sie fast immer asymptomatisch sind, werden sie meist als Zufallsbefund entdeckt. Die Diagnose wird per Szintigramm mit Technetium-99-markierten, hitzedenaturierten autologen Erythrozyten gesichert. Sollte ein Resektionseingriff erforderlich sein, so ist das der enkapsulierten Nebenmilz adhärente Organ zu schonen. Anhand dreier Fallbeschreibungen (intrapankreane Nebenmilz, retroperitoneale Nebenmilz, torsionsinfarzierte Wandermilz) wird die chirurgische Relevanz der Ektopien des Milzgewebes erörtert.

Abstract

According to autoptic studies, accessory spleens may be found in 10% to 15% of the population, in 1% to 2% they are located in the pancreatic tail. They thus have to be taken into account in the differential diagnosis of intra- and peripancreatic tumorous lesions. After splenorenal fusion, they can be found pararenally and retroperitoneally, and after splenogonadal fusion they can descend into the pelvis or scrotum. Since they usually are asymptomatic, they are mostly discovered accidentally. The diagnosis is ascertained by a scintigram with technetium-99-marked, heat-damaged red blood cells. If resection is necessary, the organ adherent to the encapsulated accessory spleen should be preserved. By means of three case reports (intrapancreatic accessory spleen, retroperitoneal accessory spleen and torsion-infarcted wandering spleen), the surgical relevance of ectopic splenic tissue is discussed.

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Literatur

  1. Aburano T, Katada R, Shuke N et al. (1997) Discordant splenic uptake of Tc-99m colloid and Tc-99m denatured RBC in candidiasis-endocrinopathy syndrome. Ann Nucl Med 11:335

    Google Scholar 

  2. Basnyat PS, Jones DA, Morgan RJ, Davies CJ, Foster ME (2001) Splenogonadal Fusion: report of a rare variety. J R Coll Edinb 46:102

    Google Scholar 

  3. Bombardiere T, Aspromonte N, Cafiero C, Fiumano F, Vasile R (2002) Wandering spleen with torsion of the pedicle. A case report and review of the literature. Chir Ital 54:417

    Google Scholar 

  4. Budzynski A, Bobrzynski A, Sacha T, Skotnicki A (2002) Laparoscopic removal of retroperitoneal accessory spleen in a patient with relapsing idiopathic thrombocytopenic purpura 30 years after classical splenectomy. Surg Endosc 16:1636

    Google Scholar 

  5. Churei H, Inoue H, Nakajo M (1998) Intrapancreatic accessory spleen: case report. Abdom Imaging 23:191

    Google Scholar 

  6. Daum R, Hecker W, Müller W (1964) Die angeborene Wandermilz. Z Kinderchir 1:143

  7. De la Monte SM and Hutchins GM (1985) Sisters with polysplenia. Am J Med Genet 21:171

    Google Scholar 

  8. Derbekyan VA, Pham C, Emond C, Novales-Diaz JA, Lisbona R (1999) Scintigraphic diagnosis of polysplenia in the adult. Clin Nucl Med 24:161

    Google Scholar 

  9. Desai DC, Hebra A, Davidoff AM, Schnaufer L (1997) Wandering spleen: a challenging diagnosis. South Med J 90:439

    Google Scholar 

  10. Dodds WJ, Taylor AJ, Erickson SJ, Stewart ET, Lawson TL (1990) Radiologic imaging of splenic anomalies. AJR 155:805

    Google Scholar 

  11. Durst J and Rohen JW (1998) Bauchchirurgie. Schattauer (Stuttgart)

  12. Eraklis AJ and Filler RM (1977) Splenectomy in childhood: A review of 1413 cases. J Pediatr Surg 7:382

    Google Scholar 

  13. Fuchs A (1985) Akutes Abdomen bei angeborener Wandermilz mit kompletter Stieldrehung im Kindesalter. Chirurg 56:59

    Google Scholar 

  14. Gamulin A, Oberholzer J, Rubbia-Brandt L, Mentha G (2002) An unusual, presumably hepatic mass. Lancet 360:2066

    Google Scholar 

  15. Germann R, Liedgens P, Brands W, Schindera F (1997) Typische Verläufe bei angeborener Wandermilz. Monatsschr Kinderheilk 145:235

    Google Scholar 

  16. Gilbert B, Menetrey C, Belin V, Brosset P, de Lumley L, Fisher A (2002) Familial isolated congenital asplenia: a rare, frequently hereditary dominant condition, often detected too late as a cause of overwhelming pneumococcal sepsis. Report of a new case and review of 31 others. Eur J Pediatr 161:368

    Google Scholar 

  17. Gilbert-Barness E, Debich-Spicer D, Cohen Jr MM, Opitz JM (2001) Evidence for the "midline" hypothesis in associated defects of laterality formation and multiple midline anomalies. Am J Med Genet 101:382

    Google Scholar 

  18. Gouw-Elema AS, Elema JD, Bink-Boelkens MT, de Jongh HJ, ten Kate LP (1985) The spectrum of splenogonadal fusion. Case report and review of 84 cases. Eur J Pediatr 144:316

    Google Scholar 

  19. Greenfield LJ (1998) Surgery—Scientific Principles and Practice. Lippincott (Phil)

  20. Halpert B and Alden ZA (1964) Accessory spleens in or at the tail of the pancreas: a survey of 2700 additional necropsies. Arch Pathol 77:652

    Google Scholar 

  21. Halpert B and Gyorkey F (1957) Accessory spleen in the tail of the pancreas. Arch Pathol 64:266

    Google Scholar 

  22. Harris GN, Kase DJ, Bradnock H et al. (1994) Accessory spleen causing a mass in the tail of the pancreas: MR imaging findings. AJR 163:1120

    Google Scholar 

  23. Hashida Y, Jaffe R, Yunis EJ (1983) Pancreatic pathology in trisomy 13: specifity of the morphologic lesion. Pediatr Pathol 1:169

    Google Scholar 

  24. Henne-Bruns D (2002) Duale Reihe Chirurgie. Thieme, Stuttgart New York

  25. Hickeson M, Derbekyan V, Lisbona R, Novalez-Diaz JA (2001) Assessment of viable splenic tissue in massive splenic infarction with Tc-99m heat-damaged RBC scan. Clin Nucl Med 26:419

    Google Scholar 

  26. Hunter TB and Haber K (1977) Sonographic diagnosis of a wandering spleen. AJR 129:925

    Google Scholar 

  27. Karaman MI and Gonzalez Jr ET (1996) Splenogonadal fusion: report of 2 cases and review of literature. J Urol 155:309

  28. Kato Y, Murayama K, Taniguchi N et al. (1998) A case of accessory spleen presenting as retroperitoneal tumor. Hinyokika Kiyo 44:711

    Google Scholar 

  29. Kobayashi H, Kawamoto S, Tamaki T, Konishi J, Togashi K (2001) Polysplenia associated with semiannular pancreas. Eur Radiol 11:1639

    Google Scholar 

  30. Lamesch P, Lamesch A (1993) Anomalies of the position of the spleen in the child. Langenbecks Arch Chir 378:171

    Google Scholar 

  31. Läuffer JM, Baer HU, Maurer CA, Wagner M, Zimmermann A, Büchler MW (1999) Intrapancreatic Accessory Spleen: a rare cause of a pancreatic mass. Int J Panc 25:65

    Google Scholar 

  32. Lippert H (1998) Praxis der Chirurgie. Thieme, Stuttgart New York

  33. Moerman P, Fryns JP, Van der Stehen K, Kleczkowska A, Lauweryns J (1988) The pathology of the trisomy 13 syndrome: a study of 12 cases. Hum Genet 80:349

    Google Scholar 

  34. Moore PJ, Hawkins EP, Galliani CA, Guerry-Force ML (1997) Splenogonadal fusion with limb deficiency and micrognathia. South Med J 90:1152

    Google Scholar 

  35. Muneta S, Sakai S, Fukuda H, Imamura Y, Matsumoto I (1992) Polysplenia syndrome with various visceral anomalies in an adult: embryological and clinical considerations

  36. Naranjo GA, Rodiguez Sanjuan JC, Casado MF, Del Castillo DJ, Pagola Serrano MA (1994) Polysplenia with partial abdominal visceral heterotaxia and small pancreas. Rev Esp Enferm Dig 85:395

    Google Scholar 

  37. Noack F, Sayk F, Ressel A, Berg C, Gembruch U, Reusche E (2002) Ivemark syndrome with agenesis of the corpus callosum: a report with a review of the literature. Prenat Diagn 22:1011

    Google Scholar 

  38. Ota T, Tei M, Yashioka A et al. (1997) Intrapancreatic accessory spleen diagnosed by technetium-99m heat damaged red blood cell SPECT. J Nucl Med 38:494

    Google Scholar 

  39. Riebel T, Lambrecht W, Amon O, Brömel T (1985) Torquierte Wandermilz. Monatsschr Kinderheilk 133:300

  40. Schutze GE, Mason Jr EO, Barson WJ et al. (2002) Invasive pneumococcal infections in children with asplenia. Pediatr Infect Dis J 21:278

    Google Scholar 

  41. Sica GT, Reed MF (2002) Intrapancreatic Accessory Spleen. Radiology 217:134

  42. Siewert JR, Harder F, Rothmund M (2000) Praxis der Visceralchirurgie—Endokrine Chirurgie. Springer, Berlin

  43. Siewert JR, Harder F, Rothmund M (2000) Praxis der Visceralchirurgie—Onkologische Chirurgie. Springer, Berlin

  44. Souparis A, Papaziogas B, Alexandrakis A, Koutelidakis J, Paraskevas G, Papaziogas T (2002) An unusual case of retroperitoneal accessory spleen with vascular supply direct from the aorta. Minerva Chir 57:513

    Google Scholar 

  45. Strouse PJ, Haller JO, Berdon WE, Rosovsky MA, Bellah RD, Barr Jr M (2002) Horseshoe adrenal gland in association with asplenia: presentation of 6 new cases and review of the literature. Pediatr Radiol 32:778

    Google Scholar 

  46. Ticho BS, Goldstein AM, Van Praagh R (2000) Extracardiac anomalies in the heterotaxy syndromes with anomalies of midline-associated structures. Am J Cardio 85:729

    Google Scholar 

  47. Tsuchiya N, Sato K, Shimoda N et al. (2000) An accessory spleen mimicking a nonfunctional adrenal tumor: a potential pitfall in the diagnosis of left adrenal tumor. Urol Int 65:226

    Google Scholar 

  48. Tsuda Y, Nishimura K, Kawakami S, Kimura I, Nakano Y, Konishi J (1991) Preduodenal portal vein and anomalous continuation of inferior vena cava: CT findings. J Comput Assist Tomogr 15:585

    Google Scholar 

  49. Wadham BM, Adams PB, Johnson MA (1981) Incidence and location of accessory spleens. N Engl J Med 304:1111

    Google Scholar 

  50. Wanebo JW (1997) Surgery for Gastrointestinal Cancer. Lippincott-Raven, Philadelphia

  51. Yang XY, Heller DS, Baergen RN (2002) Splenopancreatic field abnormality in trisomy 13. Pediatr Dev Pathol 5:414

    Google Scholar 

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Danksagung

Für die Überlassung von Bildmaterial danken wir dem Pathologischen Institut (Leiter: Prof. Dr. H. Wehner) und dem Radiologischen Institut (Leiter: Prof. Dr. P. Billmann) des Klinikums Lahr.

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  1. Klinik für Visceral-, Gefäß- und Thoraxchirurgie, Klinikum Lahr

    G. Weiand & G. Mangold

  2. Klinik für Visceral-, Gefäß- und Thoraxchirurgie, Klinikum Lahr, Klostenstraße 19, 77933, Lahr

    G. Weiand

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Weiand, G., Mangold, G. Die Nebenmilz im Pankreasschwanz—eine vernachlässigte Entität?. Chirurg 74, 1170–1177 (2003). https://doi.org/10.1007/s00104-003-0714-7

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  • DOI: https://doi.org/10.1007/s00104-003-0714-7

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