Massive postoperative splenulosis.

September 2006, Vol. 96, No. 9 SAMJ Symptomatic thrombocytopenic purpura occurred in an otherwise normal 62-year-old man. Bonemarrow studies showed features typical of peripheral sequestration and the condition was diagnosed as autoimmune. There was no response to corticosteroid administration. Laparoscopic splenectomy was uneventful and the patient remained well off all treatment. Four years later a packed cell volume, previously around 43%, started to rise beyond 50%. Investigations revealed no cause and whole-blood viscosity was controlled with occasional venesection. The patient subsequently developed nagging recurrent pain in the left iliac fossa, and the scan, normal 1 year previously, showed a large mass (Fig. 1) on the posterior gastric wall. No other pathology was noted and a clinical diagnosis of leiomyoma sarcoma was made. At operation hundreds of splenuculi were seen scattered throughout the whole abdominal cavity (Fig. 2). It transpired that the lower abdominal discomfort was due to a sizeable collection of splenic tissue in the anterior abdominal wall. With difficulty the stomach was mobilised to reveal a tumour that, on frozen section, proved to be a leiomyoma. Complete removal was possible and a distal gastrectomy was performed. Postoperative recovery was uneventful.