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Poirier A, Ben Bader M, Reibel N. Wandering spleen: Diagnosis and treatment. J Visc Surg 2024:S1878-7886(24)00064-X. [PMID: 38839447 DOI: 10.1016/j.jviscsurg.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Whether congenital or acquired, wandering spleen is a rare entity. In most cases, surgical treatment necessitates splenectomy, or even more rarely, particularly in children, splenopexy.
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Affiliation(s)
- Antoine Poirier
- Department of Visceral, Metabolic and Cancer Surgery, Nancy University Hospital - Brabois Adult Hospital, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
| | - Mourad Ben Bader
- Department of Visceral, Metabolic and Cancer Surgery, Nancy University Hospital - Brabois Adult Hospital, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - Nicolas Reibel
- Department of Visceral, Metabolic and Cancer Surgery, Nancy University Hospital - Brabois Adult Hospital, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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2
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Shibiru YA, Wondimu S, Almaw W. Wandering spleen presenting in the form of right sided pelvic mass and pain in a patient with AD-PCKD: a case report and review of the literature. J Med Case Rep 2024; 18:259. [PMID: 38790071 PMCID: PMC11127297 DOI: 10.1186/s13256-024-04580-6] [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] [Received: 12/02/2023] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not. CASE PRESENTATION We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful. CONCLUSION Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.
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Snyder EN, Rao A, Rehrig ST. Wandering Spleen After Sleeve Gastrectomy as a Cause of Sigmoid Volvulus. Cureus 2023; 15:e50447. [PMID: 38222125 PMCID: PMC10785998 DOI: 10.7759/cureus.50447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
The report highlights a rare instance of colonic volvulus due to a wandering spleen. Wandering spleen is characterized by the displacement of the spleen due to absent or weakened ligaments due to congenital factors or acquired factors such as pregnancy or prior surgery leading to ligament disruption. The 26-year-old patient presented with severe abdominal pain and distention, leading to a diagnosis of sigmoid volvulus secondary to the wandering spleen. This case underscores the importance of considering the wandering spleen in the differential diagnosis of acute abdomen, especially in patients with a surgical history of gastric sleeve resection. The article emphasizes the critical role of imaging in diagnosis and the necessity of timely surgical intervention to prevent severe complications. The case contributes to a broader understanding of the wandering spleen, particularly in post-surgical contexts, highlighting diagnostic challenges and management strategies.
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Affiliation(s)
- Elise N Snyder
- Department of Surgery, Anne Arundel Medical Center, Annapolis, USA
| | - Aniruddha Rao
- School of Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Scott T Rehrig
- Department of Surgery, Anne Arundel Medical Center, Annapolis, USA
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Khan H, Fatima K, Aman M, Khan F, Khan P, Safi MI. Wandering spleen with acute torsion mimicking an adnexal mass. Radiol Case Rep 2023; 18:4094-4098. [PMID: 37727144 PMCID: PMC10505588 DOI: 10.1016/j.radcr.2023.08.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/12/2023] [Indexed: 09/21/2023] Open
Abstract
Wandering spleen manifests when the splenic ligaments are underdeveloped, or become lax, thereby allowing the spleen to relocate from its anatomical site to more distant areas. During such movements, torsion of the long splenic peduncle is common, which can lead to symptoms of acute abdomen and further complications such as infarction. It is typically seen in children and young females. Our report presents a case of a 22-year-old female presenting to the ER with complaints of severe pain in the abdominal region. On ultrasound, there was suspicion of an adnexal mass, which was later confirmed to be a misplaced spleen in the lower abdomen, with torsion, fat stranding, and splenic vein thrombosis, as revealed by enhanced CT abdomen and pelvic MRI. It was followed by an emergency splenectomy. As wandering spleen presents nonspecifically and is a rare condition, it is important to consider wandering spleen when patients present similarly to this case, to prevent misdiagnosis and to deliver surgical treatment quickly to preserve the spleen.
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Affiliation(s)
- Hana Khan
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Kulsoom Fatima
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Aman
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Faheemullah Khan
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Poonum Khan
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Ismail Safi
- Department of Radiology, Nishtar National Kidney Hospital, Jalalabad, Afghanistan
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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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Wandering spleen with torsion and infarction: A case report. Radiol Case Rep 2022; 17:3377-3379. [PMID: 35874869 PMCID: PMC9304641 DOI: 10.1016/j.radcr.2022.06.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Wandering spleen, also known as ectopic spleen, is a rare condition in which the spleen's anatomical location is other than its fixed position in the abdomen's left upper quadrant. The cause of such an abnormality could be due to congenital or acquired factors, which could ultimately lead to torsion and splenic infarct. Given the nonspecific clinical symptoms and the potential complications associated with wandering spleen, computed tomography scans provide a crucial means for proper diagnosis. In this article, we report the case of a 16-year-old female with a diagnosis of wandering spleen with torsion and splenic infarct.
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Kachare M, Jaisinghani P. Torsion of a Wandering Spleen Involving the Pancreatic Tail and Splenic Flexure and Isolated Left-Sided Portal Hypertension due to Chronic Splenic Vein Thrombosis. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1749672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Wandering spleen is a rare entity, wherein the spleen is attached only by an elongated vascular pedicle, predisposing it to complications like hilar torsion, infarction, rupture, etc. Pancreatic volvulus is another very rare anomaly, with isolated case reports described in association with wandering spleen. The presentation varies from asymptomatic lump (stimulating a mass) to acute abdomen (due to torsion). We present a case of 26-year-old female patient who complained of pain in abdomen, and was radiologically diagnosed and surgically confirmed to have a torsion of wandering spleen with involvement of pancreatic tail and splenic flexure. Few cases with associated finding of gastric volvulus and sigmoid volvulus have been described previously. Involvement of descending colon in a 9-year-old child has been reported. However, to the authors' knowledge, this is the first case report describing the combination of wandering spleen with splenic flexure and pancreatic tail involvement in an adult.
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Affiliation(s)
- Manohar Kachare
- Department of Radiodiagnosis, Government Medical College Miraj, Miraj, Maharashtra, India
| | - Pooja Jaisinghani
- Department of Radiodiagnosis, Government Medical College Miraj, Miraj, Maharashtra, India
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Bairwa BL, Gupta S, Singh AK. Wandering spleen with torsion: a rare cause of acute abdomen in a 14-year-old girl. Arch Clin Cases 2022; 9:56-61. [PMID: 35813495 PMCID: PMC9262086 DOI: 10.22551/2022.35.0902.10204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Wandering spleen is a rare condition and defined as the spleen that is not in its normal anatomical position due to lack or laxity of suspensory ligaments. Etiological factors are congenital and acquired. Splenic torsion, infraction, and rupture are life-threatening complications of wandering spleen. A 14-year-old girl patient presented to the emergency department with severe pain abdomen for 2 days. On physical examination, a large palpable mass in the mid of the abdomen was found, and CECT confirmed it as torsion of wandering spleen. Emergency exploration is done and splenectomy was done due to non-viability of the spleen. The Post-op period was uneventful. Acute torsion of wandering spleen is an extremely rare clinical entity and patient present in an emergency with clinical features of acute abdomen. They may also present with chronic pain abdomen and abdominal mass. Early diagnosis is vital for the preservation of the spleen. Radiological studies have an important role in an accurate diagnosis. Surgery is the gold standard treatment of wandering spleen. Surgery for splenopexy or splenectomy depends on the condition of the spleen during surgery. Timely diagnosis and interventions are crucial to prevent life-threatening complications of wandering spleen.
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Multimodality imaging of developmental splenic anomalies: tips and pitfalls. Clin Radiol 2022; 77:319-325. [PMID: 35000764 DOI: 10.1016/j.crad.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/16/2021] [Indexed: 12/17/2022]
Abstract
Anomalies in number and location may occur during splenic development. This review aims to offer a brief overview of splenic function and embryology and a detailed account of the imaging appearances using different imaging techniques of the normal spleen and various congenital splenic anomalies including (1) abnormal viscero-atrial situs, (2) splenogonadal fusion, (3) intrapancreatic accessory spleen, (4) wandering spleen, and (5) splenosis. Emphasis is placed on the salient features that help radiologists recognise important associations (e.g., asplenia/polysplenia in situs abnormalities), avoid diagnostic pitfalls (e.g., mistaking intrapancreatic accessory spleen as pancreatic neoplasms), and potential complications (e.g., acute torsion in wandering spleen). The correct identification of the said anomalies from more sinister causes, such as malignancies, are essential, where early intervention is necessary.
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Torsion of the wandering spleen as an abdominal emergency: a case report. BMC Surg 2021; 21:289. [PMID: 34107944 PMCID: PMC8190838 DOI: 10.1186/s12893-021-01289-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium. Case presentation A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of the wandering spleen’s pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully. Conclusion Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.
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Guo H, Ba X, Gong P, Wang G, Ma H, Wang L, Wang Q. Abdominopelvic ectopic spleen with a comprehensive imaging examination: a case report. J Int Med Res 2021; 49:3000605211000511. [PMID: 33730926 PMCID: PMC8166395 DOI: 10.1177/03000605211000511] [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] [Indexed: 11/15/2022] Open
Abstract
Ectopic spleen is a rare clinical malformation in which the spleen is relocated from its normal anatomical position to other parts of the abdomen. We report a rare case of abdominopelvic ectopic spleen caused by splenic ligament deficiency. A patient experienced intermittent pain in the left upper abdomen that was progressively aggravated. This was confirmed by comprehensive imaging examinations and postoperative pathology. We also performed a review of the literature on the current state of the field. Our data may help to improve the diagnosis and treatment of ectopic spleen.
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Affiliation(s)
- Hao Guo
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China.,Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Xinru Ba
- Department of Radiology, Yaitai Shan Hospital, Yantai, Shandong Province, China
| | - Peiyou Gong
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Guangzhi Wang
- Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Weifang, Shandong Province, China
| | - Heng Ma
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Liying Wang
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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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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Bunyamin G, Doğan E, Özdemir M, Mihriban K. The ectopic spleen-incidental finding on pelvic magnetic resonance imaging. PRAXIS MEDICA 2021. [DOI: 10.5937/pramed2102055g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The ectopic spleen (ES) is a rare variation occurred depend on the absence or laxity of the suspensory ligaments. The ES is a rarely diagnosed clinical condition. Less than 500 symptomatic patients have been reported. Less than 0.25% of splenectomies are performed on the ES. Patients are usually asymptomatic. It's diagnosed incidentally in general. The incidence is not clear. ES incidence is reported less than 0.5%. However, this rate covers all of the relocations. The spleen can be found anywhere in the abdomen or pelvis, depends on the length of the vascular pedicle. The pelvic ES is a rarely encountered situation. Knowing this anomaly is essential for early diagnosis and prevention serious problems such as torsion, infarction and acute abdomen. A 21 years old female patient with ES was presented on pelvic magnetic resonance imaging.
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Zheng L, Li D, Wang W. Endoscopic full-thickness resection of gastric ectopic splenic nodules. BMC Gastroenterol 2020; 20:388. [PMID: 33213371 PMCID: PMC7678266 DOI: 10.1186/s12876-020-01533-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background Ectopic spleen is extremely rare. Most cases are congenital, acquired ectopic spleen may be a consequence of surgery or trauma to the spleen. The ectopic spleen in the gastric wall we reported is even rarer.
Case presentation We report a 41-year-old female patient, with a past history of splenectomy, who presented with heartburn. Gastroscopy revealed a swelling in the fundus in the stomach. Ultrasonography and computed tomographic examination suggested the possibility of gastrointestinal stromal tumor. We performed endoscopic resection of the mass. Pathological examination of the resected mass showed ectopic spleen. Conclusion When a patient with a history of splenectomy presents with a gastric submucosal tumor, ectopic spleen should also be considered in the differential diagnoses. And minimally invasive endoscopic treatment can achieve the purpose of diagnosis and treatment for unobvious submucosal tumors.
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Affiliation(s)
- Linfu Zheng
- Department of Gastroenterology, 900th Hospital of PLA, Oriental Hospital Affiliated to Xiamen University, Fujian Medical University, Fuzhou, 350025, China
| | - Dazhou Li
- Department of Gastroenterology, 900th Hospital of PLA, Oriental Hospital Affiliated to Xiamen University, Fujian Medical University, Fuzhou, 350025, China
| | - Wen Wang
- Department of Gastroenterology, 900th Hospital of PLA, Oriental Hospital Affiliated to Xiamen University, Fujian Medical University, Fuzhou, 350025, China.
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Wang Z, Zhao Q, Huang Y, Mo Z, Tian Z, Yang F, Wang Y, Yao L. Wandering spleen with splenic torsion in a toddler: A case report and literature review. Medicine (Baltimore) 2020; 99:e22063. [PMID: 32925740 PMCID: PMC7489642 DOI: 10.1097/md.0000000000022063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Wandering spleen (WS) is a rare clinical entity characterized by splenic hypermobility caused by absent or abnormal laxity of the suspensory ligaments, which fix the spleen in its normal position. Due to abnormal attachment, the spleen is predisposed to torsion and a series of complications. Pediatric WS is mostly reported in children aged <10 years, especially among infants aged <1 year; it is uncommon among toddlers between 1 and 3 years. To the authors' knowledge, only seven cases of WS have been described previously. Herein, we present the case of a 3-year-old toddler with WS and splenic torsion. PATIENT CONCERNS A 3-year-old boy was presented to the pediatric emergency room with a 2-day history of abdominal pain and vomiting. The ultrasonographic examination revealed a mass in the left upper abdomen cavity and absence of spleen in its normal position. Computed tomography showed an enlarged displaced spleen occupying the left abdomen cavity with an elongated splenic vascular pedicle (whirl sign), suggesting splenic torsion. DIAGNOSES The patient was diagnosed that had WS and splenomegaly, with or without complications due to splenic torsion. INTERVENTIONS The patient underwent emergency laparotomy and splenectomy due to nonviability after detorsion. OUTCOMES The postoperative course was uneventful, and the patient was discharged on the 7th day postoperatively without complications. The patient had favorable outcome over a 1-year follow-up. LESSONS Herein, we reported the case of a toddler with WS with splenic torsion. Moreover, after reviewing relevant studies in literature, we presented our findings on the diagnosis and treatment of toddlers with WS. Toddlers with WS are characterized by acute abdominal pain, unclear history description, examination restrictions, and high rates of life-threatening complications. High level of suspicion, careful physical examination, detailed history collection, and objective investigation are crucial in the management of toddlers with WS.
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Affiliation(s)
| | | | - Yuanyuan Huang
- Department of Pediatric Outpatient, The First Hospital of Jilin University
| | | | - Zhisen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University
| | | | - Yuanyi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun, China
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Torsion of wandering spleen: radiological findings. Emerg Radiol 2020; 27:555-560. [DOI: 10.1007/s10140-020-01786-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022]
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17
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Zavidic T, Lovrinic D, Bogovic M, Lodeta B. Postraumatic Torsion of Wandering Spleen in 9-year-old Boy. JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2020. [DOI: 10.5799/jcei/8271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Camarillo G, Kopelman Y, Daskal Y, Sheffer D. Wandering spleen: a rare complication of sleeve gastrectomy. BMJ Case Rep 2019; 12:12/12/e232494. [PMID: 31811094 DOI: 10.1136/bcr-2019-232494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The spleen is an intraperitoneal organ typically located in the left upper quadrant. Ectopic ('wandering') spleen refers to the displacement of the spleen from its normal anatomical location to another region in the abdominal cavity or pelvis. It's a relatively rare condition with no clear aetiology. We present, here, a case of a wandering spleen following sleeve gastrectomy in a 23-year-old female patient, whose spleen, prior to this event, was demonstrated by imaging in a normal anatomical position. A splenectomy was performed, and after an uneventful postoperative period, the patient was discharged. No similar case description was found in the relevant medical literature. Possible causes and decision-making process are discussed. We conclude that the wandering spleen phenomenon should be considered in the differential diagnosis of patients presenting with abdominal pain and new abdominal mass following sleeve gastrectomy.
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Affiliation(s)
| | - Yael Kopelman
- Gastroenterology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaakov Daskal
- General Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Daniel Sheffer
- General Surgery, Hillel Yaffe Medical Center, Hadera, Israel
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Nastiti NA, Niam MS, Khoo PJ. Emergency laparoscopic splenectomy for torsion of wandering spleen in a geriatric patient: A case report. Int J Surg Case Rep 2019; 61:91-95. [PMID: 31352320 PMCID: PMC6664162 DOI: 10.1016/j.ijscr.2019.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 11/24/2022] Open
Abstract
Wandering spleen is rare in geriatric / elderly population. Wandering spleen torsion may present as acute abdomen. Imaging is needed to diagnose wandering spleen. Imaging is essential in assessing splenic perfusion in case of torsion. Non-viable spleen can be managed by laparoscopic splenectomy.
Introduction Wandering spleen (WS) is an uncommon congenital or acquired condition where the spleen is displaced from its normal position at the left hypochondrium to anywhere within the abdominal or pelvic cavity. The incidence is extremely rare in the geriatric population. Presentation of Case We present a rare case of WS torsion in a 69-year-old elderly patient who presented with an acute abdomen. Physical examination revealed a tender right lower quadrant abdominal mass. Imaging studies confirmed the diagnosis of WS torsion with features of infarction. Subsequently, an emergency laparoscopic splenectomy was performed. Discussion A WS occurs due to the hypermobility of the spleen secondary to the absence or laxity of splenic suspensory ligaments. It is more commonly seen in children and adults in the third decade of life. Symptoms are usually attributed to the consequences of splenic vascular pedicle torsion. Exhibited symptoms might be unspecific; thus, radiological modalities are essential to determine the diagnosis and aid in planning its management. The treatment of choice is either open or laparoscopic splenopexy or splenectomy. Conclusion Due to potentially life-threatening consequences and the rarity of such cases, a thorough history, detailed physical examination, and objective investigation are the pillars to attain a prompt diagnosis for appropriate management to be conducted as soon as possible to minimise complications.
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Affiliation(s)
| | - Muhammad S Niam
- University of Brawijaya, Malang, 65145, East Java, Indonesia.
| | - Phong Jhiew Khoo
- Newcastle University Medicine Malaysia, Iskandar Puteri, 79200, Johor, Malaysia.
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Barabino M, Luigiano C, Pellicano R, Giovenzana M, Santambrogio R, Pisani A, Ierardi AM, Palamara MA, Consolo P, Giacobbe G, Fagoonee S, Eusebi LH, Opocher E. "Wandering spleen" as a rare cause of recurrent abdominal pain: a systematic review. MINERVA CHIR 2019; 74:359-363. [PMID: 30019879 DOI: 10.23736/s0026-4733.18.07841-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Matteo Barabino
- Unit of Hepatobiliary, Pancreatic, and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | | | | | - Marco Giovenzana
- Unit of Hepatobiliary, Pancreatic, and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Roberto Santambrogio
- Unit of Hepatobiliary, Pancreatic, and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | - Andrea Pisani
- Unit of Hepatobiliary, Pancreatic, and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
| | | | | | - Pierluigi Consolo
- Unit of Digestive Endoscopy, G. Martino Hospital, University of Messina, Messina, Italy
| | - Giuseppa Giacobbe
- Unit of Digestive Endoscopy, G. Martino Hospital, University of Messina, Messina, Italy
| | - Sharmila Fagoonee
- Institute for Biostructures and Bioimages, Center for Molecular Biotechnology, National Research Council, University of Turin, Turin, Italy
| | - Leonardo H Eusebi
- Department of Medical and Surgical Sciences, S. Orsola University Hospital, Bologna, Italy
| | - Enrico Opocher
- Unit of Hepatobiliary, Pancreatic, and Digestive Surgery, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy
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Rodríguez Vargas D, Parada Blázquez M, Vargas Serrano B. Diagnostic imaging of abnormalities in the location of the spleen and in the number of spleens. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rodríguez Vargas D, Parada Blázquez M, Vargas Serrano B. Diagnóstico por imagen de anomalías en el número y localización del bazo. RADIOLOGIA 2019; 61:26-34. [DOI: 10.1016/j.rx.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/29/2022]
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Torsion of wandering spleen in an infant associated with hamartomatous vascular malformation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Niu Y, Liu W, Xian L, Liu T, Huang C, Yang S. Thoracic splenosis presenting as pulmonary space-occupying lesion. BMC Surg 2018; 18:119. [PMID: 30572857 PMCID: PMC6302502 DOI: 10.1186/s12893-018-0461-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/13/2018] [Indexed: 11/10/2022] Open
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Viana C, Cristino H, Veiga C, Leão P. Splenic torsion, a challenging diagnosis: Case report and review of literature. Int J Surg Case Rep 2018; 44:212-216. [PMID: 29529542 PMCID: PMC5928290 DOI: 10.1016/j.ijscr.2018.02.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/07/2018] [Accepted: 02/22/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Wandering spleen is an unusual condition characterized by hypermobility of the spleen. This is a rare clinical entity and it's more common in childhood under 1 year of age and in third decade of life. In this second peak, it's more frequent in females. Clinical manifestations can vary from asymptomatic to abdominal emergency. Treatment is often surgical. PRESENTATION OF CASE We presented a case report of splenic torsion from our hospital and a review of cases described in literature. This is a 40 year-old woman with complaints of upper abdominal pain associated with nausea and vomiting. A marked tenderness and a palpable abdominal mass on left hypochondrium were found as well as a slight increase in inflammatory parameters. A CT was performed and demonstrated findings compatible with splenic torsion. Surgery was performed doing laparoscopic splenectomy; Review of literature was made using the keyword combination: "wandering spleen". The research resulted in 451 articles. DISCUSSION The physical examination and CT are fundamental for diagnosis. Surgery was performed and laparoscopic splenectomy was made because infarcted spleen; about the review of literature, the majority of patients were female and the average age at the time of diagnosis was 25.2 years. 69.5% needed splenectomy and 78.6% of surgeries were laparotomic. CONCLUSION Splenic torsion is a rare but important differential diagnosis in patients presenting with acute abdomen. Diagnosis should be made promptly before development of life-threatening complications. Surgery is often necessary and splenopexy or splenectomy can be done.
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Affiliation(s)
- C Viana
- Department of General Surgery, de Braga Hospital, Braga, Portugal.
| | - H Cristino
- Department of General Surgery, de Braga Hospital, Braga, Portugal
| | - C Veiga
- Department of General Surgery, de Braga Hospital, Braga, Portugal
| | - P Leão
- Department of General Surgery, de Braga Hospital, Braga, Portugal; Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, de Gualtar Campus, 4709-057 Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal
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Urbonas T, Crotty FE, Al-Bahrani A. Torsion of an ectopic spleen: a possible late complication of paraoesophageal hernia repair. ANZ J Surg 2015; 88:E357-E358. [PMID: 26489700 DOI: 10.1111/ans.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tomas Urbonas
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
| | - Fiona E Crotty
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
| | - Ahmed Al-Bahrani
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
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