García Angarita F and Sanjuanbenito Dehesa A
A 44 years-old-woman was admitted to our clinic because of development of thrombocytopenia and skin purpura. Abdominal ultrasonography and Computed Tomography (CT) did not show spleen or liver disorder. First line treatment with orally steroids showed a transitory response, with thrombocytopenia relapse in few months. Then laparoscopic splenectomy was accomplished successfully. The patient developed relapse in platelet count after 45 days of procedure, requiring treatment with thrombopoietic drugs and new diagnosis procedures. Nuclear medicine scintigraphy using heat-damaged Tc99m-labeled red blood cells revealed two images of uptake in left subdiaphragmatic region. Then the patient underwent intraoperative gamma-probe guidance after injection of Tc99m-labeled denatured erythrocytes, through left subcostal laparotomy with resection of two accessory spleens, one of them inside the pancreatic tail. After this procedure, the platelet count remains stable with lower dose of steroid treatment.