Pelvic splenosis implanted in Douglas pouch mimics pseudo-endometriosis symptoms: a case report study.

Introduction and importance: Pelvic splenosis is characterized by the autotransplantation of spleen fragments following tissue rupture. Since the fragments are mostly implanted into the Douglas pouch, endometriosis-like symptoms are developed, clinically. Thus, this case report demonstrated a successful surgical procedure for pelvic splenosis management. Clinical presentation: A 43-year-old woman with chronic pelvic pain was admitted to hospital. Medical history showed a car accident (at the age of 5 years) and severe spleen trauma followed by splenectomy. Patient assessment and sonography procedure revealed the presence of retrouterine mass with primary endometriosis diagnosis. Exploratory laparotomy was applied and total hysterectomy and bilateral salpingo-oophorectomy were conducted. The mass was excised and histopathologic assessment revealed the splenosis with pseudo-endometriosis symptoms. Clinical discussion: Severe spleen trauma followed by rupture can potentially lead to displaced splenic fragments. Since these tissue segments implant in Douglas pouch, anatomical relations can lead to chronic pelvic symptoms misdiagnosed with endometriosis. Conclusion: Thus, to prevent misdiagnosis and ineffective interventions, it is recommended for clinicians to consider the presence of pelvic splenosis in women with a history of acute splenic trauma and subsequent splenectomy.