Acil Servise Başvuran ve Bilgisayarlı Tomografi Çekilen Çocuk ve Ergenlerde Splenül Sıklığı

Abstract

Amaç: Aksesuar dalak olarak ta bilinen splenül, dalak dokusunun ektopik lokaizasyonlarda bulunmasıdır. Özellike cerrahi planlanacak hastalarda splenül varlığının tayini önem teşkil etmektedir. Çalışmamızın amacı acil service başvuran kontrastlı ve kontrastsız bilgisayarlı tomografi (BT) çekimi yapılan çocuklarda (0-17 yaş) splenül sıklığını belirlemektir. Gereç ve Yöntemler: Mayıs 2015 – Eylül 2022 tarihleri arasında acil servise başvuran ve batın BT ile tetkik edilen 748 çocuk hasta içerisinden çekim protokolü eksiği olan, travmatik dalak hasarı olan veya hematolojik hastalık öyküsü olan olgular çalışma dışı bırakılarak (n: 100) toplam 648 olgu çalışmaya dahil edildi. BT görüntüleri gerek splenül lokalizasyonu gerekse hacimleri açısından incelendi. Bulgular: Çalışmaya 467 erkek (%72.1) ve 181 kadın (%27.9) oldu arasından 131 olguda (%20.2) splenül tespit edildi. Splenül tespit edilenlerde erkek / kız oranı 3/1 idi. 21 olguda birden fazla splenül tespit edildi. Toplamda 159 splenül izlenmiş olup tespit edilen splenüllerin ortalama hacmi 0.72 ±0.95 ml ve en sık yerleşim yeri dalak hilusu (n=55, %41.9) olarak tespit edildi. Sonuç: Çalışmamız sık bir anatomik varyant olan splenül’ün çocuk yaş grubunda %20 oranında görüldüğünü göstermiştir. Bu kadar sık görülen bir anatomik varyantın tedavi amacıyla splenektomi planlanan çocuk hasta grubunda operasyon öncesinde mutlaka görüntüleme ile mümkünse kesitsel görüntüleme ile splenül varlığı, lokalizasyonu ve adeti belirlenmesi önerilir.

Keywords

• Abdomen
• aksesuar dalak
• kontrastlı bilgisayarlı tomografi
• kontrastsız bilgisayar tomografi
• pediatri
• splenül

Splenule Frequency on Computed Tomography Scans in Children, Presenting to The Emergency Department

Abstract

Objectives: Accessory spleen, also known as “splenule”, is the presence of splenic tissue in ectopic localisations. The presence of splenule is important, especially in patients planned for splenectomy, as it may cause refractory symptoms. The aim of the present study is to define the frequency of splenule(s) in children (0-17 years) who received non-contrast and contrast enhanced computed tomography (NECT and CECT) protocols in the emergency department. Material and methods: 748 children (aged 0 to 17 years) who were admitted to the emergency department between May 2015 – September 2022 and had NECT and CECT abdominal scans were included in the study. Patients whose CT protocols were incomplete and cases with traumatic splenic injury and / or cases with poor image quality and patients with a history of splenectomy or hematologic pathology were excluded from the study (n: 100). A total of 648 patients were included in the cohort. NECT and CECT scans of all patients were assessed; the localisation of splenules as well as the antero-posterior (AP), medio-lateral (ML) and cranio-caudal (CC) dimensions of each splenule were measured. Results: A total of 648 cases with 467 males (72.1%) and 181 females (27.9%) were included in the study. Splenules were observed in 131 (20.2%) cases. More than one splenule was observed in 21 of these 131 cases. A total number of 159 splenules were observed in total, with a mean volume of 0,72 ±0,95 ml. The most common location was found to be the splenic hilus (n=55, 41.9%). Conclusion: Our study have stated that splenules are common anatomical variants, seen at a rate of 20,2% in this age cohort. A cross-sectional imaging should be performed to determine the presence, location, and number of the splenules before a planned splenectomy.

Keywords

• Abdomen
• accessory spleen
• contrast enhanced computed tomography
• non-contrast enhanced computed tomography
• pediatric
• splenule

References

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2. 2. Depypere L, Goethals M, Janssen A, Olivie F. Traumatic rupture of splenic tissue 13 years after splenectomy. A case report. Acta Chirurgica Belgica. 2009;109(4):523-526.
3. 3. Pandey SK, Bhattacharya S, Mishra RN, Shukla VK. Anatomical variations of the splenic artery and its clinical implications. Clin Anat. Sep 2004;17(6):497-502. doi:10.1002/ca.10220
4. 1. Arkuszewski P, Srebrzyński A, Niedziałek L, Kuzdak K. Accesory Spleen-Incidence, Localization and Clinical Significance. Comparative Professional Pedagogy. 2010;9(82):510-514.
5. 2. Depypere L, Goethals M, Janssen A, Olivie F. Traumatic rupture of splenic tissue 13 years after splenectomy. A case report. Acta Chirurgica Belgica. 2009;109(4):523-526.
6. 3. Pandey SK, Bhattacharya S, Mishra RN, Shukla VK. Anatomical variations of the splenic artery and its clinical implications. Clin Anat. Sep 2004;17(6):497-502. doi:10.1002/ca.10220