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Ferrara D, Vallone G, Russo S, Rossi E, Riccio C, Rinaldo AM, Zeccolini R, Zeccolini M, Esposito F. Volvulus of a wandering spleen in a pediatric patient. Radiol Case Rep 2024; 19:2864-2867. [PMID: 38689812 PMCID: PMC11058064 DOI: 10.1016/j.radcr.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 05/02/2024] Open
Abstract
Wandering spleen is a rare condition in children that is often caused by the loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication. A 13-year-old boy who had been showing abdominal pain in the hypogastric region accompanied by vomit and an enormous tumefaction in the suprapubic region came to our observation. Considering the ovoid morphology at ultrasound exam, the echostructure and the marked reduction of parenchymal vascularization, suspicion for torsion of an ectopic spleen arose. Ultrasound evaluation has a primary role in the diagnosis of a suspected wandering spleen and, to avoid potentially life-threatening complications, immediate surgery is often times required.
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Affiliation(s)
- Dolores Ferrara
- Department of Radiology, “A.O.R.N. Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Gianfranco Vallone
- Life and Health Department “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Silvana Russo
- Pediatric Surgery Unit, “A.O.R.N. Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Eugenio Rossi
- U.O.S.D. Diagnostic Imaging P.O. Pausilipon, “A.O.R.N. Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Ciro Riccio
- Department of Advanced Biomedical Sciences, University of Naples Federico II Unina, Naples, Italy
| | - Andrea Maria Rinaldo
- Department of Advanced Biomedical Sciences, University of Naples Federico II Unina, Naples, Italy
| | - Raffaele Zeccolini
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Massimo Zeccolini
- Department of Radiology, “A.O.R.N. Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Francesco Esposito
- U.O.S.D. Division of Emergency Imaging Department “A.O.R.N. Santobono-Pausilipon”, Children Hospital, Naples, Italy
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Nhungo CJ, Nsato SB, Lwakatare FA, Mbaga AA, Lyimo FR, Mwanga AH. Wandering Spleen in a 47-year-old female treated by non-operative conservative management. Case report and literature review. Int J Surg Case Rep 2024; 120:109834. [PMID: 38823227 PMCID: PMC11176938 DOI: 10.1016/j.ijscr.2024.109834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION Wandering spleen (WS) is a rare clinical condition found in less than 0.5 % of splenectomies and is characterized by ectopic location of the spleen within the abdomen or pelvis. It is always caused by excessive mobility brought on by the ligamentous laxity of its peritoneal attachments. Abdominal ultrasonography and computed tomography are the key imaging modalities for inquiry of WS. CASE PRESENTATION We report the case of a 47-year-old woman who presented with painless abdominal swelling since the age of 6 years. An abdominal examination revealed a palpable, firm, mobile mass in the right lower abdomen approximately 15 × 15 cm in dimensions. A contrast CT scan of the abdomen revealed the absence of the spleen in the left upper quadrant. The patient was managed conservatively and followed for five years with favourable outcome. DISCUSSION Failure of the dorsal mesogastrium to merge with the posterior abdominal wall in the second month of embryonic development is one of the reasons for WS. The nonsurgical conservative approach is limited to patients who are high-risk surgical candidates and have minimal symptoms and no complications. CONCLUSION The good clinical outcome of our patient suggests that conservative non-surgical approach may be a reasonable alternative to unwarranted surgical intervention in selected clinically stable patients who have no evidence of splenic torsion or infarction, avoiding the possible complications of surgery.
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Affiliation(s)
- Charles John Nhungo
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Sylvia Bedas Nsato
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Flora A Lwakatare
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Amina A Mbaga
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Frederick R Lyimo
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Ally Hamis Mwanga
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
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Moore E, O’Brien JW, Merali N, Farkas N, Madhavan A, Abbassi-Ghadi N, Preston S, Singh P. Gastric outlet obstruction secondary to a wandering spleen: systematic review and surgical management of a case. Ann R Coll Surg Engl 2023; 105:501-506. [PMID: 36688842 PMCID: PMC10313450 DOI: 10.1308/rcsann.2022.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION A wandering spleen occurs when laxity or absence of the suspensory ligaments allows migration throughout the abdomen. Gastric outlet obstruction resulting from this abnormality is rare. We present a systematic literature search and a case that was managed successfully with surgical intervention at our centre. METHODS A systematic search of the PubMed, Embase™, Medline® and Google Scholar™ databases was carried out employing the combined search terms "gastric outlet obstruction" AND "wandering spleen". Six results were included for final analysis. RESULTS All six search results described a single case each. Patients underwent surgical management (open or laparoscopic) after initial investigation utilising a range of modalities. There were no mortalities reported at 90 days. The single case we present was complicated by gastric perforation; the patient made a successful recovery following open splenopexy and stapled wedge resection of the stomach. CONCLUSIONS A wandering spleen is a rare diagnosis and there are only six reported cases of gastric outlet obstruction secondary to a wandering spleen in the literature. None report associated gastric perforation. There are a variety of presenting symptoms, intraoperative findings and operative techniques used to address the gastrosplenic abnormality. The case reported by our centre adds to this limited evidence base and demonstrates a successful outcome from definitive surgical management. We highlight the need to seek early gastro-oesophageal expertise if any gastric pathology is found together with anatomical abnormality of the spleen.
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Affiliation(s)
- E Moore
- Royal Surrey NHS Foundation Trust, UK
| | | | | | | | | | | | - S Preston
- Royal Surrey NHS Foundation Trust, UK
| | - P Singh
- Royal Surrey NHS Foundation Trust, UK
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Ahmad H, Hamdar H, Nahle AA, Martini N, Alkhatib Z. A wandering spleen with 720° torsion and persistent ascending and descending mesocolon in a 5-year-old Syrian male: A case report. Int J Surg Case Rep 2023; 107:108319. [PMID: 37263001 DOI: 10.1016/j.ijscr.2023.108319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The spleen is normally found in the left hypochondrium and it is fixed in its place by numerous suspensory ligaments. When the ligaments are elongated or abnormally developed, it causes a rare medical condition called Wandering spleen. A persistent ascending and descending mesocolon is also a congenital anomaly, resulting from the failure of fusion of the primitive dorsal mesocolon. CASE PRESENTATION Herein, a 5-year-old male child with sudden and acute onset of abdominal pain, constipation, nausea, tachycardia, and low urine output, imaging and blood tests revealed evidence of intestinal obstruction and normocytic anemia and neutrophilia. A laparotomy revealed persistent ascending and descending mesocolon, with a torsioned vascular pedicle of the spleen, resulting in splenomegaly and infarction. The surgeon successfully derotated the torsioned pedicle and performed a splenectomy. The patient had an uneventful postoperative course and was discharged without complications. CLINICAL DISCUSSION This case could be asymptomatic and the diagnosis is incidental or it could be presented with ambiguous symptoms. The differential diagnosis of WS varies according to the clinical presentation and the associated complication. For instance, in the case of WS torsion and acute presentation, the differential diagnosis is ovarian torsion, acute appendicitis, and intestinal obstruction. Currently, surgery is the only suggested treatment option even in asymptomatic patients as well. CONCLUSION This case of a Wandering Spleen is associated with a persistent ascending and descending mesocolon, suggesting that there may be certain risk factors. Therefore, we suggest making more research about wandering spleen in association with persistent mesocolon.
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Affiliation(s)
- Hiyam Ahmad
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Hussein Hamdar
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Ali Alakbar Nahle
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Nafiza Martini
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic.
| | - Zaed Alkhatib
- Ibn Al-Nafees Hospital, Damascus, Syrian Arab Republic
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Zhao S, Wang Y, Wan Z, Chen H, Zhao X, Li R. A case report of wandering spleen with pedicle torsion and splenic infarction being misdiagnosed as organ inversion complicated with acute appendicitis. Front Surg 2022; 9:916426. [PMID: 36147692 PMCID: PMC9485545 DOI: 10.3389/fsurg.2022.916426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
Wandering spleen is a rare disease that is easily misdiagnosed. When combined with splenic pedicle torsion and even splenic infarction, wandering spleen is a rare and critical cause of surgical acute abdomen. We report an 18-year-old male patient with abdominal organ inversion diagnosed as acute appendicitis before operation. Laparoscopic exploration confirmed wandering spleen with splenic pedicle torsion led to splenic infarction and was complicated by appendicitis. He was treated with laparoscopic appendectomy and abdominal splenectomy. The patient recovered well after the operation and was discharged from the hospital in 7 days. During the 4-year follow-up, there was no report of complicated infections such as pneumonia or sepsis.
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Affiliation(s)
- Shengjie Zhao
- Ambulatory Surgery Center, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
| | - Yindi Wang
- Ambulatory Surgery Center, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, China
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Ganarin A, Fascetti Leon F, La Pergola E, Gamba P. Surgical Approach of Wandering Spleen in Infants and Children: A Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:468-477. [PMID: 33428514 DOI: 10.1089/lap.2020.0759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Splenopexy has been proposed as the treatment of choice in case of wandering spleen (WS). We report our experience and review the current literature focusing on surgical management and outcomes of children affected by WS. Materials and Methods: Data regarding demographics, clinical manifestations, diagnosis, and treatment of children treated for WS at our Institution were analyzed. Systematic review was registered on Prospero (CRD42018089971). Scientific databases were searched using defined keywords. Articles were selected using predefined exclusion and inclusion criteria. Analysis was conducted adding our center's cases. Results: One hundred sixty-six articles were included in the review, 197 cases were analyzed, 3 of which unpublished. Female/male ratio was 1.5:1 and median age at diagnosis was 8 years. Most frequent clinical manifestation was isolated abdominal pain (42.6%). Torsion of splenic pedicle was diagnosed in 56.3%. Among surgical procedures, 39% underwent splenopexy and 54.8% underwent splenectomy. In case of splenopexy, the most commonly used techniques were using of a mesh (45.5%) or creation of a retroperitoneal pouch (30.9%). In 48.2% of splenopexies, minimally invasive surgery (MIS) was used. Splenopexy was effective in 94.8% (88% considering only cases with a spleen torsion). Conclusion: WS is a rare condition potentially leading to torsion of the spleen. This entity has to be kept in mind as a differential diagnosis in case of abdominal pain. Splenopexy should be the treatment of choice; its success rate in terms of preserved spleens can be affected by the presence of a torted organ. Retroperitoneal pouch or mesh fixation are the most preferred techniques. Authors recommend MIS approach.
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Affiliation(s)
- Alba Ganarin
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Enrico La Pergola
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
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Bourusly M, Ayed M, Bahzad Z. Case Report: Conservative Non-operative Management of a Neonate With Torted Wandering Spleen. Front Pediatr 2021; 9:791932. [PMID: 35155313 PMCID: PMC8832051 DOI: 10.3389/fped.2021.791932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The management of wandering spleen (WS) with torsion, a rare pathological condition, is currently unclear. Most patients with this disorder are treated with surgical interventions, such as splenectomy or splenopexy. CASE PRESENTATION A newborn female presented with low hemoglobin (10.8 mg/L) and high total serum bilirubin (193 μmol/L) at 3 h of life. A palpable mass was observed during her physical examination, and a magnetic resonance imaging scan of the abdomen confirmed the presence of an infarcted WS with torsion. Upon conservative management with oral antibiotic prophylaxis, careful observation, and repeated follow-ups, the infant remained clinically stable. At 2 years of age, she had normal complete blood count, and a repeat technetium study revealed two splenunculi/splenules in the splenic bed. CONCLUSION Most patients with WS are treated surgically with splenectomy or splenopexy. Non-operative management may be a feasible treatment option in select cases with infarcted WS and may allow the natural process of autosplenectomy to occur.
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Affiliation(s)
- Maha Bourusly
- Pediatric Hematology Oncology Department, National Bank Kuwait Specialized Children Hospital, Kuwait City, Kuwait
| | - Mariam Ayed
- Neonatal Department, Farwaniya Hospital, Kuwait City, Kuwait
| | - Zainab Bahzad
- Pediatric Department, Farwaniya Hospital, Kuwait City, Kuwait
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Virani P, Farbod A, Niknam S, Akhgari A. Wandering spleen with splenic torsion: Report of two cases. Int J Surg Case Rep 2020; 78:274-277. [PMID: 33373922 PMCID: PMC7776122 DOI: 10.1016/j.ijscr.2020.12.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022] Open
Abstract
Anatomical variation of the spleen’s position in the abdomen, is a rare condition called Wandering Spleen (WS). WS is a vital differential diagnosis in patients presenting with acute abdomen. Concerning the high incidence of splenic torsion in these patients, early recognition is important. We report two cases of this rare condition, prersenting with splenic torsion and abdminal pain.
Introduction and importance Anatomical variation of the spleen’s position in the abdomen, is a rare condition called Wandering Spleen (WS). WS is a vital differential diagnosis in patients presenting with acute abdomen and diagnosis should be made promptly to prevent development of serious complications. Case presentation In this article, we report two cases of WS (27 and 20 years old females) presenting with abdominal pain due to splenic torsion. Both Patients underwent splenectomy and discharged with no further complications. Clinical discussion The presentation of a wandering spleen varies from an asymptomatic mass to an acute abdomen due to torsion and splenic infarction, therefore recognition of this condition can be challenging. Diagnosis depends on imaging studies, and treatment options consist of performing either splenectomy or splenopexy. Conclusion Concerning the high incidence of splenic torsion and infarction in WS patients, early recognition of this condition and initiation of apt intervention is of great significance.
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Affiliation(s)
- Peyman Virani
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Farbod
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saman Niknam
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aisan Akhgari
- Medical Student, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
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Schaeffer WJ, Mahmood SMJ, Vermillion SA, Sweet R, Haas NL. Splenic volvulus of a wandering spleen. Am J Emerg Med 2020; 41:265.e1-265.e3. [PMID: 33041134 DOI: 10.1016/j.ajem.2020.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/01/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Wandering spleen is a rare condition in which the spleen is not anchored properly, due to congenital or acquired weakness of the splenic ligaments. This allows the spleen to migrate to any portion of the abdomen or pelvis, and can cause complications, including a splenic volvulus. The presentation of splenic volvulus of a wandering spleen ranges from mild pain to a surgical emergency. Splenic volvulus of a wandering spleen can cause significant morbidity and mortality, and often warrants surgical intervention. Cases of splenic volvulus of a wandering spleen have been reported in radiology and surgery literature, however there are no reports in emergency medicine literature in North America. CASE REPORT A 37-year-old female presented to the ED with seven days of mild left upper quadrant abdominal pain that acutely worsened. She underwent laboratory studies which were near her baseline values. A CT abdomen pelvis demonstrated findings consistent with splenic volvulus of a wandering spleen. She was taken emergently to the operating room for exploratory laparotomy, detorsion of spleen, and splenectomy. Her postoperative course was uneventful and she was discharged on hospital day six. Splenic volvulus of a wandering spleen is rare, though carries significant morbidity and mortality, especially if unrecognized. The presentation of splenic volvulus is variable, ranging from minor symptoms to an acute abdomen. Early diagnosis can prevent downstream complications, including development of vascular congestion, ischemia or infarcted intra-abdominal organs. Emergency Physicians should consider splenic volvulus in the differential diagnosis as an etiology of left-sided abdominal pain.
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Affiliation(s)
- William J Schaeffer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - S M Jafar Mahmood
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sarah A Vermillion
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Raphael Sweet
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nathan L Haas
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA
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The Importance of Recognizing Wandering Spleen as a Cause of Recurrent Acute Pancreatitis. Case Rep Gastrointest Med 2018; 2018:7573835. [PMID: 30034889 PMCID: PMC6032662 DOI: 10.1155/2018/7573835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/30/2018] [Indexed: 11/17/2022] Open
Abstract
Wandering spleen, as its name suggests, is a rare condition where the spleen wanders in the abdomen and is most commonly found in the inferior quadrant as a palpable mass. It can have varying presentations and commonly presents as splenic torsion and very rarely as acute pancreatitis. It is imperative not to miss this diagnosis as it can lead to life-threatening complications in the form of splenic torsion/infarction. Here we describe a rare manifestation of wandering spleen where a young female presented with recurrent episodes of acute pancreatitis.
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Aguirre Pascual E, Fontanilla T, Pérez Í, Muñoz B, Carmona MS, Minaya J. Wandering spleen torsion-use of contrast-enhanced ultrasound. BJR Case Rep 2016; 3:20150342. [PMID: 30363305 PMCID: PMC6159283 DOI: 10.1259/bjrcr.20150342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 06/06/2016] [Indexed: 12/16/2022] Open
Abstract
We report a case of torsion of a wandering spleen in an 18-year-old male patient who presented with acute abdominal pain and left lower quadrant mass. The patient was initially misdiagnosed at another institution. The patient came to our hospital for further investigation. Contrast-enhanced ultrasound was performed and showed a solid hypoechoic avascular mass, which was all that remained of the spleen, located under the left kidney. Based on the ultrasound findings, CT scan and MRI of the abdomen were performed to confirm the suspicion of torsion of a wandering spleen. To the best of our knowledge, there are no case reports describing the use of contrast-enhanced ultrasound for diagnosing torsion of a wandering spleen.
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Affiliation(s)
| | - Teresa Fontanilla
- Department of Radiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Íñigo Pérez
- Department of Radiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Beatriz Muñoz
- Department of Radiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Maria Soledad Carmona
- Department of Radiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Javier Minaya
- Department of Radiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Sharma A, Salerno G. A torted wandering spleen: a case report. J Med Case Rep 2014; 8:133. [PMID: 24886115 PMCID: PMC4031896 DOI: 10.1186/1752-1947-8-133] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction A torted wandering spleen is a rare clinical occurrence with fewer than 500 cases reported and an incidence of less than 0.2%. It is brought about through laxity of the gastrosplenic and splenorenal ligaments; however, the precise aetiology remains unknown. It can prove to be a diagnostic challenge with high mortality if misdiagnosed. Case presentation We present the case of a 27-year-old woman of Arabic ethnicity, who complained of a short history of severe abdominal pain with the background of recurrent abdominal pain and vomiting. An abdominal computerized tomography scan revealed a torted wandering spleen. This required a splenectomy due to splenic infarction. Conclusion This report highlights the investigations and management necessary for a patient who presents with an ischaemic torted wandering spleen.
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Affiliation(s)
- Aman Sharma
- FY2 in Paediatric Surgery at John Radcliffe, Headley Way, Oxford OX3 9DU, UK.
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Rellum R, Risseeuw G, Blaauw ID, Lequin M. Splenorenal collaterals as hallmark for a twisted wandering spleen in a 14-year-old girl with abdominal pain: a case report. European J Pediatr Surg Rep 2014; 2:26-8. [PMID: 25755964 PMCID: PMC4336078 DOI: 10.1055/s-0034-1370776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/27/2013] [Indexed: 11/15/2022] Open
Abstract
Wandering spleen is a rare cause of acute or chronic recurrent abdominal pain with a risk of splenic torsion and infarction. We describe a case of a 14-year-old girl with chronic recurrent abdominal pain with a palpable spleen in normal position on the initial physical examination. Laboratory findings were normal. A normal blood flow was seen on the initial (color Doppler) sonography. Magnetic resonance imaging showed an enlarged spleen in the pelvic region with torsion of hilar pedicle and splenorenal collaterals. Semielective, a laparoscopic splenopexy was performed without complications. A twisted wandering spleen should be included in the differential diagnosis of recurrent abdominal pain despite possible normal positioning of the spleen. The presence of splenorenal collaterals on imaging techniques can be used as a diagnostic hallmark.
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Affiliation(s)
- Rashidi Rellum
- Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Gerard Risseeuw
- Department of Radiology, Ruwaard van Putten Hospital, Spijkenisse, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud Medical Centre, Nijmegen, The Netherlands
| | - Maarten Lequin
- Department of Radiology, Sophia Childrens Hospital, Rotterdam, The Netherlands
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Lombardi R, Menchini L, Corneli T, Magistrelli A, Accinni A, Monti L, Tomà P. Wandering spleen in children: a report of 3 cases and a brief literature review underlining the importance of diagnostic imaging. Pediatr Radiol 2014; 44:279-88. [PMID: 24407229 DOI: 10.1007/s00247-013-2851-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 09/06/2013] [Accepted: 10/02/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Wandering spleen is a rare condition in children that is often caused by loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication. OBJECTIVE To provide up-to-date information on the diagnosis, clinical management and diagnostic imaging approaches for wandering spleen in infants and children and to underline the importance of color Doppler US and CT in providing important information for patient management. MATERIALS AND METHODS We report a series of three children with wandering spleen treated at our children's hospital over the last 6 years. All three underwent clinical evaluation, color Doppler US and CT and were surgically treated. We also reviewed 40 articles that included 55 patients younger than 18 years reported in the Medline database from 2002 to 2012. RESULTS We correlated pathological data with imaging findings. Color Doppler US, the first imaging modality in investigating abdominal symptoms in children with suspected wandering spleen, yielded a diagnostic sensitivity of 54.9%, whereas CT achieved about 71.7%. CONCLUSION Radiologic evaluation has a major role in confirming the diagnosis of a suspected wandering spleen and avoiding potentially life-threatening complications requiring immediate surgery.
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Affiliation(s)
- Roberta Lombardi
- Department of Radiology, Bambino Gesù Pediatric Hospital, P.zza S. Onofrio, 4-00165, Rome, Italy,
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Memari M, Nikzad M, Nikzad H, Taherian A. Wandering spleen in an adult man associated with the horseshoe kidney. ARCHIVES OF TRAUMA RESEARCH 2013; 2:129-32. [PMID: 24693523 PMCID: PMC3950916 DOI: 10.5812/atr.9332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 05/20/2013] [Accepted: 05/29/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A wandering spleen occurs when there is a laxity of the ligaments that fix the spleen in its normal anatomical position. CASE PRESENTATION This is a case report of a wandering spleen with horseshoe kidney in a 29-year-old male admitted with acute lower abdominal pain and vomiting to emergency department of Shariati hospital in Isfahan province. Sonographic examination showed a homogeneous 21 × 15 × 8 cm mass in the lower part of the abdomen and pelvis associated with a horseshoe kidney. Laparotomy confirmed the clinical and ultrasound findings. CONCLUSIONS The association of horseshoe kidney with a wandering spleen in this case may be due to an embryological anomaly.
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Affiliation(s)
| | - Mohsen Nikzad
- Faculty of Medicine, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Hossein Nikzad
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Hossein Nikzad, Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3615550480, Fax: +98-3615550480., E-mail:
| | - Aliakbar Taherian
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Bekheit M, Katri KM, Ezzat T. Wandering hemi-spleen: Laparoscopic management of wandering spleen in a case of polysplenia. Int J Surg Case Rep 2012; 3:151-4. [PMID: 22382032 DOI: 10.1016/j.ijscr.2011.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Several congenital anomalies of the spleen have been reported. The polysplenia is a rare anomaly in which the normal spleen is replaced with two or more smaller spleens. The wandering spleen is another anomaly resulting from the laxity of the splenic ligaments. The concomitance of both anomalies is very rare. PRESENTATION OF A CASE A 22-year old female patient presented with intermittent left hypochondrial pain for more than a year. After a thorough examination of the patient, she only had bilateral accessory nipples. Routine laboratory investigations were all normal. An abdominal ultrasound U/S scan was unremarkable except for a ptotic spleen. with a large splenule 5cm×3cm located near the fundus of the stomach. These findings were confirmed by a CT scan. A decision for a surgical intervention was then made, and the laparoscopic approach was chosen which revealed the condition. Laparoscopic removal of the wandering part was executed. The patient discharged on the first post-operative day. DISCUSSION The decision making in cases of wandering spleen is not always the same. The association of a wandering spleen with polysplenia is an asset to the surgical decision, along with the age of the patient. CONCLUSION The laparoscopic approach is an important tool in the diagnosis and management of wandering spleen. The diagnosis of polysplenic anomaly could provide a guidance for the surgical strategy in patients with wandering spleen.
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Broadis E, Banda MK, Molyneux EM, Borgstein E. Paediatric wandering spleens in Malawi. Malawi Med J 2011; 22:120-1. [PMID: 21977832 DOI: 10.4314/mmj.v22i4.63948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- E Broadis
- Department of Surgery, College of Medicine, Blantyre
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Arleo EK, Kovanlikaya A, Mennitt K, Acharya S, Brill PW. Multimodality imaging of a neonatal wandering spleen. Clin Imaging 2010; 34:302-5. [PMID: 20630344 DOI: 10.1016/j.clinimag.2009.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 08/20/2009] [Indexed: 11/25/2022]
Abstract
Wandering spleen, a rare entity, is caused by the absence or laxity of the normal anchoring splenic ligaments. Only three neonatal cases have been reported in the English-language literature. We present the clinical and multimodality imaging findings of a newborn with laceration and hemorrhage of a wandering spleen. The course was complicated by the concurrent diagnosis of glucose-6-phosphate dehydrogenase deficiency, which confused the clinical picture when a falling hematocrit raised the question of rebleeding several days after presentation.
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Affiliation(s)
- Elizabeth Kagan Arleo
- Department of Radiology, and Department of Pediatrics, New York Presbyterian Hospital-Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
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Fiquet-Francois C, Belouadah M, Ludot H, Defauw B, Mcheik JN, Bonnet JP, Kanmegne CU, Weil D, Coupry L, Fremont B, Becmeur F, Lacreuse I, Montupet P, Rahal E, Botto N, Cheikhelard A, Sarnacki S, Petit T, Poli Merol ML. Wandering spleen in children: multicenter retrospective study. J Pediatr Surg 2010; 45:1519-24. [PMID: 20638536 DOI: 10.1016/j.jpedsurg.2010.03.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 03/07/2010] [Accepted: 03/07/2010] [Indexed: 11/26/2022]
Abstract
Wandering spleen in children is a rare condition. The diagnosis is difficult, and any delay can cause splenic ischemia. An epidemiologic, semiological, and surgical diagnosis questionnaire on incidence of wandering spleen in children was sent to several French surgical teams. We report the results of this multicenter retrospective study. Fourteen cases (6 girls, 8 boys) were reported between 1984 and 2009; the age range varies between 1-day-old and 15 years; 86% were seen in the emergency department. Ninety-three percent had diffuse abdominal pain. For 57% of the cases, it was their first symptomatic episode of this type. No diagnosis was established based on the clinical results alone. All patients had presurgical imaging diagnosis. Open surgery was performed on 64% cases. Forty-three had splenectomy for splenic ischemia. Thirty-six percent had splenopexy, 14% had laparoscopic gastropexy, and 7% had spleen repositioning and regeneration. Complications were noted in 60% of the cases resulting in postsplenopexy splenic ischemia. Early diagnosis and surgery are the best guarantee for spleen preservation. Even if the choice of one technique, splenopexy or gastropexy, can be argued, gastropexy has the advantage of avoiding splenic manipulation and restoring proper physiologic anatomy. When there is no history of abdominal surgery, laparoscopy surgery seems the best procedure.
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Affiliation(s)
- Caroline Fiquet-Francois
- Pediatric Surgery Department, American Memorial Hospital, Centre Hospitalier Universitaire, 51092 Reims France.
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Abstract
Wandering spleen is a rare condition that can lead to splenic infarction or rupture if torsion persists. Early diagnosis and intervention are necessary, and abdominal ultrasonography and abdominal computed tomography are well accepted as the diagnostic imaging modalities. In this study, we present a boy with nic infarction due to acute torsion of a wandering spleen, after initial failure to demonstrate an ectopic spleen. Instead, acute torsion of the wandering spleen with spontaneous partial detorsion was incidentally found by multi-detector row CT with angiography. The patient was managed by splenectomy instead of splenopexy, because poor reperfusion after Laparoscopic detorsion.
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Affiliation(s)
- Chi-Hone Lien
- Department of Pediatrics, Mackay Memorial Hospital, Hsin Chu Branch, Taiwan
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22
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Panagoulias G, Tentolouris N, Ladas SS. Abdominal pain in an adult with Type 2 diabetes: A case report. CASES JOURNAL 2008; 1:154. [PMID: 18798976 PMCID: PMC2556666 DOI: 10.1186/1757-1626-1-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 09/17/2008] [Indexed: 11/10/2022]
Abstract
Introduction Chronic abdominal pain (CAP) may be a manifestation of diseases involving many intra-abdominal organs. Beside diseases affecting subjects without diabetes mellitus, diabetic patients may have CAP due to diabetes-related complications like neuritis, motor diseases of the gastrointestinal tract and autonomic dysfunction. Atherosclerosis is 2–4 times more common in patients with diabetes and affects mainly carotid, coronary, iliac and lower limb arteries as well as aorta. Another less common complication is chronic mesenteric ischemia (CMI, intestinal angina), caused by atherosclerotic obstruction of the celiac artery and its branches and results in episodic or constant intestinal hypoperfusion. Case presentation We present a case of a diabetic patient with CMI in whom the diagnosis was delayed by almost 5 years. The dominant symptoms were crampy abdominal postprandial pain, anorexia, changes in bowel habits and cachexia. Conventional angiography revealed significant stenosis of the celiac artery and complete obstruction of the inferior mesenteric artery. Noteworthy, no significant stenoses in carotids or limbs' arteries were found. Revascularization resulted in clinical improvement 1 week post-intervention. Conclusion CAP in patients with diabetes may be due to CMI. The typical presentation is crampy postprandial abdominal pain in a heavy smoker male patient with long-standing diabetes, accompanied by anorexia, changes in bowel habits and mild to moderate weight loss. At least two of the three main splanchnic arteries must be significantly occluded in order CMI to be symptomatic. The diagnostic procedure of choice is conventional angiography and revascularization of the occluded arteries is the radical treatment.
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Ben Ely A, Seguier E, Lotan G, Strauss S, Gayer G. Familial wandering spleen: a first instance. J Pediatr Surg 2008; 43:E23-5. [PMID: 18485931 DOI: 10.1016/j.jpedsurg.2007.12.077] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 12/24/2007] [Accepted: 12/27/2007] [Indexed: 10/22/2022]
Abstract
We report on 2 sisters presenting with acute torsion of a wandering spleen within a 3-year interval. The diagnosis was made preoperatively by computed tomography (CT) in both cases. A high index of suspicion because of our experience with the first patient, who underwent splenectomy, enabled a correct early diagnosis in the sibling. On urgent surgery, reversible ischemic changes were found, and detorsion and splenopexy resulted in preservation of the spleen.
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Affiliation(s)
- Anna Ben Ely
- Department of Diagnostic Imaging, Sackler Faculty of Medicine, Tel Aviv University, Assaf Harofeh Medical Center, Zrifin 70300, Israel.
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25
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Amer HZ, Chin C, Clarke K, Heller D. Infarcted ectopic spleen presenting as retroperitoneal mass. J Minim Invasive Gynecol 2007; 14:660-2. [PMID: 17848333 DOI: 10.1016/j.jmig.2007.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Accepted: 04/27/2007] [Indexed: 11/20/2022]
Abstract
Wandering or ectopic spleen is an exceptionally rare condition. Because of the abnormally long pedicle, an ectopic spleen is prone to torsion and infarction. Patients can present with abdominal pain or an acute abdomen. The incidence is over a wide age range, but it occurs with a female predominance in the third to fifth decades. We present a case in a 26-year-old female of an infarcted ectopic spleen, initially thought to be a retroperitoneal mass on computed tomography scan, but found at surgery in the lower abdomen. The minimally invasive gynecologic surgeon needs to be aware of this entity, which may rarely be encountered.
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Affiliation(s)
- Hoda Zeinab Amer
- Department of Pathology and Laboratory Medicine, University of Medicine and Dentistry of New Jersey--New Jersey Medical School, Newark, New Jersey 07101, USA
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Abstract
Various congenital anomalies may affect the spleen, starting with common anomalies, such as an accessory spleen, up to rare conditions such as a wandering spleen and polysplenia. Most of these anatomic variants have no clinical significance; they need, however, to be recognized by the radiologist as such. Awareness of these variants is important for the radiologist to interpret the findings correctly and avoid mistaking them for a clinically significant abnormality. In this review we illustrate the spectrum of congenital anomalies of the spleen and stress pitfalls and possible complications resulting from these anomalies.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zrifin, Israel.
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