Splenosis presenting as occult gastrointestinal bleeding

A 48-year-old man presented with recurrent gastrointestinal bleeding and an emia. Routine endoscopic evaluation was nondiagnostic, Angiography demonstr ated multiple apparent arteriovenous malformations. Exploratory laparotomy revealed numerous splenic implants along the small and large bowels, some o f which had apparently eroded through the bowel mucosa and bled. Excision o f these penetrating lesions prevented further bleeding. An incidentally not ed renal cell cancer was also resected, The patient's splenosis was the res ult of childhood trauma that caused splenic rupture and precipitated splene ctomy. Splenosis develops frequently following traumatic splenic rupture. E xperimental evidence suggests that the presence of an intact spleen suppres ses the growth and development of splenic implants. Following splenectomy, splenules may replace some of the "housekeeping" and immunologic functions of the spleen, but even patients with documented splenosis should be consid ered functionally hyposplenic. While in most cases splenules cause no sympt oms, splenosis must be considered in the differential diagnosis of previous ly splenectomized patients who present with unexplained masses or occult bl eeding. (C) 2000 Wiley-Liss, Inc.