A patient undergoing splenectomy for a hematological disorder continues to have persistent symptoms postoperatively. Imaging suggests the presence of an accessory spleen.
Where is the most common location of an accessory spleen?
Decoding the Stem
Explanation
E. Hilum of spleen: ✅ Correct. This is the most common site (~75%). Accessory spleens arise due to the failure of splenic tissue fusion during embryogenesis. In conditions like ITP or hemolytic anemia, they must be removed, otherwise the disease will persist.
C. Around tail of pancreas: ❌ Incorrect. This is the second most common site and an important surgical pitfall.
A & B. Ligaments: These are possible locations but significantly less frequent than the hilum.
D. Omentum: ❌ Rare location.
🧠Splenic Pearls
| Rank | Location |
|---|---|
| #1 (Most Common) | Splenic Hilum |
| #2 | Tail of Pancreas |
| Incidence | 10–30% of general population |
| Significance | Failure of splenectomy in ITP/Hereditary Spherocytosis |
Integrated Clinical Questions
1. What is the embryological origin of an accessory spleen?
2. Why is it clinically important to identify an accessory spleen during surgery for ITP?
3. What is the best imaging modality to locate a suspected accessory spleen postoperatively?
4. Where is the second most common location of an accessory spleen?
5. Name a common hematological condition that often requires splenectomy and careful search for accessory spleens.
⚡ Exam Pearls
- Hilum = Most Common (Remember "H" for Hilum and Highest Frequency).
- Tail of Pancreas = Second Most Common (Don't fall for the trap).
- Failed Splenectomy: Always consider an overlooked accessory spleen if symptoms recur.
0 Comments