Reddit reviews Pocket Surgery (Pocket Notebook Series)

Curious enough, it is 10 - 30% more common in patients with hematologic disorders. It is just splenic tissue (or
another spleen, to make things easier) found most commonly in these locations:

• Splenic hilum (40-60%) and lower pole;
  
• Tail of the pancreas;
  
• Suspensory ligaments;
  
• Greater omentum;
  
• Rare: presacral region, adjacent to left ovary, and in scrotum next to left testicle.
  
  (Source: Pocket Surgery, 2nd ed)
  
  The clinical vignette present in my card is a patient with known history ITP, following-up 6m after splenectomy, still presents with ITP signs and normal peripheral blood smear (when you would expect the post-splenectomy smear findings, like Howell-Jolly bodies, target cells etc.).
  
  Per UpToDate:
  
  >Patients with ongoing severe ITP after splenectomy and standard pharmacologic therapies are considered to have chronic refractory ITP. Occasionally, an accessory spleen causes late recurrence of ITP following splenectomy, especially if the initial splenectomy resulted in remission for at least one year [46]. In such cases, the possibility of an accessory spleen should be investigated with abdominal ultrasound or computed tomography. In one series, 10 percent of adult patients with chronic refractory ITP were found to have an accessory spleen [46]. This possibility is further suggested if Howell-Jolly bodies (picture 1) are absent on the peripheral smear following splenectomy.
  
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  You can also check my card for more info, it is quite comprehensive I think (also there's a good image from Pocket Surgery attached). :)