Laparoscopic resection of an accessory spleen in a patient with chronic lower abdominal pain.

During a diagnostic laparoscopy in a patient with chronic lower abdominal pain we found a pediculated accessory spleen (AS) near the left adnex. The pedicle was dissected by ultrascision, it was cut by an Endo GIA, and the AS was extracted. AS occurs in 25-40% of the population. They are always situated on the left side: hilum of the spleen, splenic artery, pancreas, splenocolic ligament, greater omentum, mesenterium, adnexal region, and scrotum. In most cases they are asymptomatic. In hematological disorders they can take over the function of the original spleen after splenectomy. Sometimes, AS can mimic tumors in other organs, such as pancreas, kidney, or liver. Likewise, there are descriptions of AS in the scrotum, the spermatic cord, the adnexes, the uterus, the stomach, the small intestine, or the heart. In rare cases they can cause pain because of cysts, abscesses, hemorrhage, or spontaneous rupture. In acute pedicle torsion an infarction can be caused presenting as acute abdomen, which is most often seen in young patients. In our case the pain was caused by pedicle torsions or mechanical irritation of the adnex. The cause of the changing localization of the pain was the long pedicle. In describing this case, we point out the advantage of diagnostic laparoscopy in patients with chronic lower abdominal pain.