Splenic haemangioma with subcapsular and peritoneal rupture

Case contributed by Dr Fakhry Mahmoud Ebouda

Presentation

Abdominal swelling and left hypochondrial pain long time ago.

Patient Data

Age: 7 Years
Gender: Male

Marked splenomegaly of heterogenous texture. It shows a 37.2 x 25.8 mm hypoechoic area. Dilated splenic vein and perihilar collaterals. The spleen is highly vascular. Mild amount of ascites.

The spleen appears massively enlarged and heterogeneous.

Medially, it is displacing the pancreas and bowel loops to right and inferiorly.

Anterosuperiorly it is abutting the stomach and left hepatic lobe with indistinct intervening fat plan. Anterolaterally it is abutting the abdominal wall.

Posteriorly: it is abutting and compressing the left kidney.

After contrast injection, the spleen shows heterogeneous enhancement. On delayed venous phase patchy enhancement is seen, suggestive of large splenic haemangioma.

Enlarged liver, the splenic and portal vein appears dilated and tortuous with evidence of portal hypertension.

Fluid is seen around spleen and in pelvis, denoting leakage and possible rupture of haemangioma.

Intraoperative laparoscopic photo for splenic haemangioma.

Gross pathology of splenic haemangioma.

Case Discussion

The case was operated laparoscopically and the surgeon extended the incision to deliver the enlarged spleen. It is proved to be a bleeding splenic haemangioma. Splenic haemangioma is regarded as the commonest benign splenic tumour and the second commonest focal lesion involving the spleen.

Thanks to Dr. Mehat Al Sayed, Prof of paediatric surgery for the intra-operative and gross pathology photo.

The case is courtesy of Dr. Mehat Al sayed, Prof. of pedia surgery and Dr. Sikander Ali, Radiology consultant RCMC.

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Case information

rID: 29767
Case created: 20th Jun 2014
Last edited: 29th Aug 2016
Inclusion in quiz mode: Included

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