Teaching Case

Recurrent episodes of vague upper abdominal pain. History of chronic obstructive pulmonary disease.

The patient presented with recurrent episodes of vague upper abdominal pain. History revealed chronic obstructive pulmonary disease. Physical examination and laboratory tests were irrelevant. Endoscopy of the esophagus, stomach and duodenum was normal. Ultrasonography (not shown) and CT scan of the abdomen were performed, followed by endosonography of the upper GI tract.

Accessory spleens are found in 10% of the population. They usually occur in the gastrosplenic ligament, but may be found in the pancreas, GI tract and even scrotum. Approximately 15% of the ectopic spleens are found in the pancreatic tail. Spleniculi are histologically identical to the normal spleen. They arise early in embryonic life from failure of complete coalescence of normal primordial splenic buds. They are seldom larger than 1.5 cm in diameter and are usually asymptomatic.
Esophageal cysts may occur in the wall of the esophagus or in the paraesophageal region. They may be congenital (rare) or acquired. Embryologically they result from developmental errors occurring in the fifth to eight week of life. Esophageal duplication cysts are most frequently intramural lesions. They can be lined with respiratory, enteric, gastric or squamous epithelium. Histological differentiation between esophageal, bronchogenic and neurogenic cysts is very difficult. Clinical presentation is variable, most cysts are asymptomatic. Those attached to the esophagus and protruding into the posterior mediastinum may cause respiratory symptoms. Cysts from the lower third of the esophagus may produce dysphagia, nausea, vomiting and weight loss.