Splenosis of Douglas Fossa 15 Years After Traumatic Splenectomy Mimicking Pelvic Masses

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Splenosis of Douglas Fossa 15 Years After Traumatic Splenectomy Mimicking Pelvic Masses

Imagine going for a routine obstetric checkup 15 years after a life-saving spleen removal—and finding unexpected pelvic masses. That’s exactly what happened to a 49-year-old woman, whose case reveals a rare but crucial condition called splenosis: when tiny pieces of spleen tissue survive trauma or surgery and grow in new places.

The woman’s story, reported by Zhong Jia, Shi-Jie Li, and Jia-Qing Huang from the Department of Hepatobiliary Surgery at the Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, began with a routine exam. She had no symptoms, but ultrasound showed unconnected masses (1–4 cm) near her uterus, and a CT scan revealed soft-tissue shadows with no enhancement—clues that something unusual was going on.

Her medical history held the key: 15 years earlier, she’d had her spleen removed after a traumatic accident. Doctors quickly suspected ectopic spleen autotransplantation (ESAT)—a fancy term for splenosis, where stray spleen fragments take root and grow.

What Is Splenosis?

Splenosis happens when small pieces of spleen tissue break off during injury or surgery and attach to other parts of the body. Most often, these fragments settle in the abdomen or pelvis (like the Douglas fossa, the lowest part of the pelvic cavity). Studies show the condition is usually asymptomatic—meaning it causes no pain or problems—and the fragments can even keep some normal spleen function, like protecting against severe infections (a critical benefit for people without a spleen).

How Do Doctors Diagnose It?

In this case, the woman’s splenectomy history and imaging results pointed to splenosis. To confirm, doctors might use:

  • Radionuclide splenic imaging: A scan using a small amount of safe radioactive material to spot spleen tissue.
  • Fine-needle biopsy: Taking a tiny tissue sample to check for spleen cells.
  • Laparoscopy: A minimally invasive surgery to look inside the pelvis.

But for this patient, surveillance was better than intervention. She had no symptoms, and the masses didn’t look like cancer. So doctors sent her home with regular checkups—and at 1 year, the masses were unchanged.

When Is Treatment Needed?

Splenosis rarely requires treatment unless it causes complications (like small bowel obstruction) or is hard to tell apart from cancer. For asymptomatic cases, watching and waiting is often best—especially since the fragments can preserve some spleen function.

Why This Case Matters

This story highlights two key points:

  1. Splenosis can hide in unexpected places: The Douglas fossa is a rare spot for spleen implants, but the case suggests it might be a backup if the omentum (a fatty layer that usually catches stray tissue) is missing.
  2. It’s crucial to distinguish splenosis from cancer: Pelvic masses often spark fear of malignancy, but splenosis is benign—and treating it unnecessarily could remove helpful tissue.

The patient gave her full consent for her case to be published, with efforts to protect her privacy.

This case, originally published in the Chinese Medical Journal in 2019, reminds us that even rare conditions can teach us valuable lessons about how the body heals. For anyone with a history of spleen trauma or removal, unexpected masses don’t always mean the worst—sometimes, they’re just the body doing its best to adapt.

Chinese Medical Journal 2019;132(2):245–246. doi:10.1097/CM9.0000000000000075
References:

  1. Ksiadzyna Peña AS. Abdominal splenosis. Rev Esp Enferm Dig 2011;103:421–426. PMID:21867352.
  2. Papakonstantinou C, Christoforidis E, Vasiliadis K, Kanellos I, Zarogoulidis K. Thoracic splenosis twenty-nine years after traumatic splenectomy mimicking intrathoracic neoplasm. Eur Surg Res 2005;37:76–78. doi:10.1159/000083151.
  3. Zhang JH, Yin JL, Wang XL, Ling YC, Quan JT. Ectopic splenic autotransplantation following traumatic injury: a case report. Exp Ther Med 2015;10:1973–1975. doi:10.3892/etm.2015.2732.
  4. Lameiras R, Matos AP, Luz C, Palas J, Ramalho M. Pelvic splenosis-a very unusual location. BJR 2016;3:1–4. doi:10.1259/bjrcr.20160026.
  5. Tandon YK, Coppa CP, Purysko AS. Splenosis: a great mimicker of neoplastic disease. Abdom Radiol 2018;43:3054–3059. doi:10.1007/s00261-018-1601-5.

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