TÍTULO

SPLENOSIS IN PATIENT WITH SCHISTOSOMA MANSONI INFECTION WHO UNDERWENT SPLENECTOMY AND AUTO IMPLANTATION OF SPLEEN TISSUE IN THE MAJOR OMENTUM THIRTY SEVEN YEARS AGO: CASE REPORT

INTRODUÇÃO

Splenosis has been widely reported around the world with an incidence of 16-67% after traumatic splenic rupture or splenectomy, however, long term follow-up of intentional splenosis after splenectomy, ligature of the left gastric vein and auto implantation of spleen morsel in the major omentum for portal hypertension in children due to mansonic schistosomiasis (MS) is rare or not yet published. The purpose of this report is the presentation of a patient with patent splenosis in abdominal surgery for pain with the diagnosis of tail pancreas tumor.
This is the first report of long-term follow-up (more than 37 years) from a child who underwent splenectomy and auto implantation off spleen morsels in the major omentum.

RELATO DE CASO

VL, 39 year-old, born in the north eastern region of Brazil (hyperendemic for schistosomiasis mansoni), underwent laparotomy for abdominal pain with the diagnosis of a pancreatic mass in its tail. The preoperative image investigation (computed tomography) showed several nodules in the upper portion of abdomen and a mass in the tail of the pancreas with close relationship with the stomach. Presumptive diagnosis was pancreatic tumor (Frantz's tumor). She underwent laparotomy partial resection of the pancreas with removal of the mass, which was sent for histology. It was observed the intentional splenosis, which was anatomically very good (resembling an accessory spleen), which was not involved in the pancreas mass. Her post-operative was with no complication. In the long past (childhood) she had had splenectomy, ligature of the left gastric vein and auto implantation of spleen morsels in the major omentum when she was 13 year-old, due to esophageal hemorrhage caused by portal hypertension due to hepatosplenic Schistosomiasis mansoni. At that time she also had hypersplenism and low body development. After surgery, she grew up as normal adolescent with no esophageal bleeding and no repeated infection nor overwhelming post splenectomy infection (OPSI). She married and gave birth of a normal child who is now 14 year-old.

DISCUSSÃO

This is a very successful case of auto implantation of spleen morsels in the major omentum, after splenectomy and ligature of the left gastric vein, in a patient with, at childhood, severe esophageal bleeding due to portal hypertension caused by hepatosplenic schistosomiasis mansoni. The reported case highlights the importance of maintaining some spleen tissue after splenectomy, in children, for spleen removal either due to trauma or benign disease, as it was the present report. The relationship between hepatosplenic Schistosomiasis mansoni has been reported and it is under investigation.