Intraperitoneal splenosis: a simple diagnosis if you remember to think of it

A 72-year old man presented with clinical signs of small bowel obstruction. The medical history revealed an asymptomatic retrogastric tumor 5 cm in diameter with impression of the gastric fundus that was found 10 years ago and showed no progression. This diagnosis was made endoscopically, by endosonography and abdominal computed tomography. Finally, as the small bowel obstruction occurred, an explorative laparotomy was performed to clarify the ambiguous abdominal scenario. The intraoperative situs showed multiple red nodules with diameters of up to 1 cm based on the serosa of the small bowel. The histopathological assessments of the peritoneal nodules as well as of the resected retrogastric tumor revealed the diagnosis of splenosis. Retrospectively, the patient reported a road accident with splenic rupture and splenectomy more than 30 years ago. He had simply forgotten this fact and thus had not mentioned it to the examining doctors. The decisive hint for the diagnosis of splenosis results from the thorough inquiry of the medical history, revealing experienced splenectomy. Splenosis should be considered as a crucial differential diagnosis of unexplained masses or occult bleeding in individuals who underwent splenectomy to avoid unnecessary diagnostic or therapeutic procedures.