Exceptionally Enlarged Accessory Spleen Due to Portal Hypertension

Accessory spleens, also known as supernumerary spleens, splenunculi, or splenules, are congenital foci of healthy splenic tissue that are separate from the main body of the spleen [1]. They are found incidentally in 10-30% of patient at autopsy, mostly at the hilum of the spleen and ad-jacent to the tail of pancreas in size of few millimeters to 2-3cm [1-3]. Reported 14 yr. old female child present with fever, pain abdomen, and generalized swelling. child have severe pallor and massive hepatosplenomegaly of 5cm and 7cm respectively with a lump of approximate size of 7cmx3cm involving umbilicus and left hypocondrium and confirmed as exceptionally enlarge accessory spleen in USG abdomen. CT scan confirmed presence of portal hypertension with collateral. Hematology revealed pancytopenia with normal hb elec-trophoresis. It has been reported that accessory spleens undergo compensatory hypertrophy as a result of pre-vious splenectomy, which sometime reaches 3-5 cm in size [19] .The accessory spleen seen in the present case seems to be exceptionally large due to portal hypertension[20]. Unusual presentation of massive splenomegaly with significant pancytopenia and portal hypertension may lead to exceptionally enlarge accessory spleen.