Splenic hemangioma with subcapsular and peritoneal rupture

Case contributed by Dr Fakhry Mahmoud Ebouda


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 hemangioma.

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 hemangioma.

Intraoperative laparoscopic photo for splenic hemangioma.

Gross pathology of splenic hemangioma.

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 hemangioma. Splenic hemangioma is regarded as the commonest benign splenic tumor and the second commonest focal lesion involving the spleen.

Thanks to Dr. Mehat Al Sayed, Prof of pediatric 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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