PRESERVATION OF THE ACCESSORY SPLEEN LOCATED IN THE GASTROSPLENIC LIGAMENT DURING TOTAL GASTRECTOMY IN A PATIENT WITH GASTRIC CARCINOMA AND A HISTORY OF SPLENECTOMY (CASE REPORT)

Abstract

The article describes a case report of the successful preservation of an accessory spleen that underwent hypertrophy during total gastrectomy and was located in the greater omentum, in a patient with adenocarcinoma of the gastric cardia and a history of splenectomy 17 years earlier due to splenic rupture from an accident. A 57-year-old male patient with a diagnosis of adenocarcinoma of the gastric cardia and with a history of splenectomy due to splenic rupture in the car accident, total gastrectomy was planned. The patient has had an accessory spleen underwent hypertrophy in the greater omentum that was visualized on CT of the size of 50 mm × 45 mm (it was 20 × 15 mm on splenectomy). On laparotomy, a soft tumor-like structure of 6.0 cm x 5.0 cm was palpated under the left hemidiaphragm within the gastrosplenic ligament attached to the parietal peritoneum by intensive adhesions. The tumor-like structure was considered to be an accessory spleen become hypertrophic. Total gastrectomy with D2 extended lymph node dissection was performed and the accessory spleen was preserved taking into consideration its blood supply. Postoperative period was without peculiarities. In the short-term postoperative period and 3 months later Doppler ultrasonography of the accessory spleen was conducted and a characteristic spleen structure and normal blood flow was observed. According to authors’ opinion, in patients with gastric cancer and with the history of splenectomy, preservation of the existing accessory spleen located in the gastrosplenic ligament is rational and it can be realized without compromising its blood supply.