1e:T45a,Abstract One of the important stages during splenectomy is the search for accessory spleens. The average frequency of accessory spleens is an estimated 11%. In our own material in 611 patients who had splenectomy in hematological disorders, accessory spleens were found in 110 patients (18%). The surgical anatomy, embryology, and clinical significance of the accessory spleens, with particular reference to the recurrence of idiopathic thrombocytopenic purpura (ITP) are discussed. The group of 177 patients with ITP treated by splenectomy 2–25 years ago is analyzed. Recurrence of thrombocytopenia after a good immediate response to splenectomy developed in 52 patients. In 13 patients the recurrence was transient, but in 19 it was longlasting. In these patients the presence of the accessory spleens was suspected by the absence of Howell‐Jolly bodies in the peripheral blood. The accessory spleen was demonstrated by splenic scan in 16 cases and confirmed in 13 of the 15 patients who underwent reoperation. Removal of the accessory resulted in permanent disappearance of thrombocytopenia in 12 patients .1f:T44c,Of 481 splenectomies performed at the University of Utah, Salt Lake City, 78 (16.2%) were for immune (idiopathic) thrombocytopenic purpura (ITP). The mean platelet count prior to therapy was 13,800/cu mm (range, 500 to 80,000/cu mm). All but two patients were initially treated with corticosteroids, and 58.2% responded with an increase in platelets (mean, 77,900/cu mm). The indications for splenectomy included (1) failure to respond to steroids (33.8%); (2) inability to taper steroids (52.1%); (3) recurrent ITP (5.6%); and (4) miscellaneous (8.5%). There was one death following splenectomy, and the postoperative morbidity was 14.1%. Complete remission occurred in 77.3%, and 84.8% were judged to have benefited from the procedure. The remission rate following splenectomy in patients who responded to preoperative steroids was 93.2%, whereas improvement fell to 68.3% in patients who failed to respond to steroids. This study confirms the benefit of splenectomy for ITP and demonstrates a predictive correlation with response to preoperative preparation with corticosteroids in these patients.20:T446,Despite their small size, accessory spleens are clinically important. Hematologists have long emphasized their occasional role in the reexacerbation of hematologic disease after initially beneficial splenectomy.^1-7Accessory spleens have been known to rupture,⁸twist on their pedicles and strangulate,^5,6,9cause bowel obstruction,¹⁰and produce defects on upper gastrointestinal radiographs suggestive of gastric neoplasms.^11,12Although accessory spleens are well recognized as acauseof disease, there is little published evidence to suggest that their apparent frequency may be theresultof disease. Anatomy textbooks tend to mention the infrequent presence of accessory spleens as an anatomic fact devoid of pathological significance. Settle states, "the accessory spleen is an anomaly [which is the] result of a development abnormality in the embryo."⁶Downey¹³and Arey¹⁴share this belief. To some degree this is true, as substantiated by the occasional presence of accessory spleens in normal21:T49b,Not all patients who undergo splenectomy for idiopathic thrombocytopenic purpura (ITP) respond to operation. This may be due to the presence of an accessory spleen. This is a report of three patients who underwent successful accessory splenectomy after relapse of their disease. Each patient initially experienced a complete response to splenectomy, but recurrence occurred months to years later. All of the patients had persistent Howell-Jolly bodies on peripheral blood smear, yet two of the patients had complete and sustained remissions of their disease after accessory splenectomy. Intraoperative localization of an accessory spleen may be exceedingly difficult in the patient who has undergone a previous operation. However, localization of accessory

	Year	Citations

References