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Wandering Spleen - A Possible Cause of Adrenal “Mass” - Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Wandering spleen is a very rare clinical condition characterized by spleen absence in the normal anatomical location in the upper left quadrant of the abdomen and its presence at another location in the abdomen or pelvis. The ectopic spleen is extremely rare in children, where its increased mobility is the result of a congenital disturbance of the fixation for the anterior wall due to the absence or weakness of the supporting ligaments. Wandering spleen is usually asymptomatic, but its torsion is possible, as well as infarction or rupture which demand an urgent diagnosis and surgical treatment. The diagnosis of wandering spleen can easily be overlooked due to low incidence and insufficient clinical experience, which multiplies patient's risk from life-threatening conditions. We present a case of wandering spleen in an 11-year-old girl with acute abdominal pain, which after ultrasound examination raised suspicion on the right adrenal gland tumor. Additional diagnostics verified an ectopic spleen in the right adrenal box, after which the recommended preventive splenopexy was seriously considered. Due to the fixation of the vital spleen in the new position, but also the negative attitude of the parents towards the surgical intervention, clinical monitoring was selected, with exclusion of intense physical activity that carries the risk of traumatization of the spleen. As the girl has been in good health for over 3 years and without symptoms, we consider that the selection of conservative access although difficult, was correct. We hope that our experience in treating wandering spleen in girls will increase the number of valid facts about this rare condition.
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Bough GM, Gargan KE, Cleeve SJ, Farrell S. Diagnosis, management and outcome of splenic torsion; a systematic review of published studies. Surgeon 2021; 20:e296-e305. [PMID: 34666939 DOI: 10.1016/j.surge.2021.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/17/2021] [Accepted: 08/22/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Splenic torsion is a rare condition but one that many surgeons will encounter once in their career. Management options are varied but due to the rarity of the condition there are no contemporary evidence-based summaries to inform a treating clinician. We aim to describe patterns of presentation and provide an evidence-based guide to the management. METHODS A PRISMA structured meta-analysis was conducted of all published cases of splenic torsion and a recent case added from our institution. RESULTS 408 cases were identified between 1888 and 2021 and a single case added from our institution, 312 cases were sourced from case reports and 96 from 40 case series. 8% of patients had a co-existing congenital anomaly and 28% an identified risk factor for splenic torsion. 82% required emergency surgery. A preoperative diagnosis is becoming more common, reaching 80% in 2020's. While spleen conserving surgery is feasible using a variety of techniques. splenectomy was the definitive management for the majority (82%). On histopatholy no occult disease was identified and a significant number of resected spleens were potentially viable; 32% were reported to be normal or congested and 14% demonstrated only partial or focal necrosis. DISCUSSION Despite the significant publication bias implied by the methodology this is a large dataset in a rare condition. Splenic torsion frequently occurs in a premorbid population. The presence of a palpable mass in the context of abdominal pain should increase suspicion and trigger cross sectional imaging. Conservation of the spleen, using the techniques discussed, should be seriously considered.
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Affiliation(s)
- Georgina M Bough
- Department of Paediatric Surgery, The Royal London Hospital, London, UK; Department of Paediatric Surgery, Addenbrookes Hospital, Cambridge, UK.
| | | | - Stewart J Cleeve
- Department of Paediatric Surgery, The Royal London Hospital, London, UK
| | - Stephen Farrell
- Department of Paediatric Surgery, Addenbrookes Hospital, Cambridge, UK
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Midha G, Surendran S, Yacob M, Samarasam I. 'Wandering spleen with acute torsion' : a rare indication for splenectomy in an adult, complicated by postoperative splanchnic venous thrombosis and intestinal gangrene. BMJ Case Rep 2021; 14:14/2/e238647. [PMID: 33541983 PMCID: PMC7868251 DOI: 10.1136/bcr-2020-238647] [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: 02/06/2023] Open
Abstract
Wandering spleen (WS) is a hypermobile spleen that, due to the laxity of its ligaments, is prone to torsion. We report a case of a 45-year-old multiparous woman who presented with acute abdominal pain and a tender palpable mass. A contrast-enhanced computed tomography scan of the abdomen showed a WS with torsion. She underwent an emergency splenectomy and was discharged after an uneventful recovery. She was readmitted with splanchnic venous thrombosis and was managed with therapeutic low-molecular-weight heparin (LMWH) and discharged. Twenty days later, she presented with new-onset abdominal pain. She had not complied with LMWH as advised. The thrombosis had progressed, leading to small bowel gangrene, requiring resection and a stoma. Due to frequent metabolic disturbances, an early reversal of stoma was performed. She was lost to follow-up thereafter. This case highlights a rare indication for emergency splenectomy and one of its major postoperative complications.
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Affiliation(s)
- Geet Midha
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suraj Surendran
- General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Myla Yacob
- General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Inian Samarasam
- General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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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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Abaszadeh F, Taebi M, Nikzad Jamnani H. Torsion of Wandering Spleen Attached to the Omentum: A Rare Case Report from Iran. Int J Gen Med 2020; 13:333-336. [PMID: 32612378 PMCID: PMC7322114 DOI: 10.2147/ijgm.s248259] [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] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/09/2020] [Indexed: 12/28/2022] Open
Abstract
Background Wandering spleen is a rare condition with less than 0.2% prevalence, and it is the cause of 0.25% of total splenectomies. This condition happens as a result of the lack or looseness of the spleen suspensory ligaments, and it may manifest as an acute abdomen due to the spleen becoming twisted around its vascular base. Case Presentation This study reports the case of a wandering spleen attached to the omentum (with blood supply from the omentum) in the pelvic area, with ectopic appendix (located in the right upper quadrant), ectopic liver (located in the abdominal midline), and ectopic stomach (located in the right upper abdominal region), in a 15-year-old male complaining about abdominal pain, nausea, vomiting, and lack of appetite, who was referred to the hospital. The patient underwent laparotomy with the diagnosis of acute abdomen; the twisted ectopic spleen in the pelvis was removed and appendectomy was also performed. The clinical manifestations of wandering spleen vary extensively, and its presurgical diagnosis is difficult in the absence of radiological studies. Therefore, spleen torsion has to be considered as a diagnosis for acute abdomen in order to prevent necrosis of the spleen and other related complications. Conclusion Wandering spleen should be borne in mind for patients presenting with a palpable intra-abdominal mass causing acute or intermittent abdominal symptoms.
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Affiliation(s)
- Farzad Abaszadeh
- Department of Operation Room Nurse, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mozhgan Taebi
- Department of Anesthesiology, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Assaf R, Shebli B, Alzahran A, Rahmeh AR, Mansour A, Hamza R, Alaasy Alkushti E, Ayoub K. Acute abdomen due to an infarction of wandering spleen: case report. J Surg Case Rep 2020; 2020:rjz378. [PMID: 32082535 PMCID: PMC7024078 DOI: 10.1093/jscr/rjz378] [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: 11/02/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 12/03/2022] Open
Abstract
Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all spleen ligaments that fixate the spleen in the left upper quadrant. Many different terms refer to wandering spleen like dislocated spleen, ectopic spleen and displaced spleen. We report in this case a 13-year-old Syrian girl presented to the emergency department complaining of acute generalized abdominal pain with fever, anorexia and vomiting started 2 days prior to presentation. A splenectomy was performed, with uneventful postsurgical follow-up. Wandering spleen is prone to torsion and infarction resulting in acute abdomen and a life-threatening condition with high mortality rate reaching 50%. We advise the investigation of any recurrent episodes of chronic pain keeping up within mind this diagnosis.
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Affiliation(s)
- Ragheb Assaf
- Faculty of Medicine, Department of Pediatric Surgery, Aleppo University Hospital
| | | | | | | | | | - Rama Hamza
- Faculty of Medicine, University of Aleppo
| | | | - Kusay Ayoub
- Department of Surgery, Aleppo University Hospital
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Colombo F, D'Amore P, Crespi M, Sampietro G, Foschi D. Torsion of wandering spleen involving the pancreatic tail. Ann Med Surg (Lond) 2019; 50:10-13. [PMID: 32021685 PMCID: PMC6994766 DOI: 10.1016/j.amsu.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022] Open
Abstract
Background Wandering spleen (WS) is a rare clinical entity resulting from the absence or maldevelopment of the ligaments normally involved in the attachment of the spleen in its normal position. WS can be a cause of acute abdomen leading to different complications ranging from torsion of the vascular pedicle to spleen infarction. Often, in absence of symptoms, it is an occasional finding during radiological exams and surgery represents the gold standard in the management of this unusual condition. Case presentation We present a case of wandering spleen in a young nulliparous female with an history of recurrent abdominal pain. A preoperative CT-scan of the abdomen showed the presence of a multi-infarcted spleen twisted several times around its vascular pedicle, involving the tail of pancreas. The patient was electively treated with laparoscopic splenectomy. Conclusions A laparoscopic approach is feasible in the treatment of this pathology. A correct and timely diagnosis of this condition is crucial to allow an organ preserving surgery. There are only few reported cases in literature describing an involvement of the tail of the pancreas in the torsion of the vascular pedicle. Complete excision of the ectasic veins tributaries of the splenic vein avoids the risk of postoperative vein thrombosis and bleeding.
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Affiliation(s)
- Francesco Colombo
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
| | - Pierluigi D'Amore
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
| | - Michele Crespi
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
| | - Gianluca Sampietro
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
| | - Diego Foschi
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
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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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10
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Awan M, Gallego JL, Al Hamadi A, Vinod VC. Torsion of wandering spleen treated by laparoscopic splenopexy: A case report. Int J Surg Case Rep 2019; 62:58-61. [PMID: 31445501 PMCID: PMC6717052 DOI: 10.1016/j.ijscr.2019.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 01/06/2023] Open
Abstract
Wandering spleen. Laparoscopic splenopexy. Torsion of splenic pedicle.
Introduction A wandering spleen is a mobile spleen as a result of deficient splenic peritoneal ligaments and elongation of its vascular pedicle. It is a rare entity affecting mainly young adults commonly females and children, presenting as an asymptomatic abdominal mass or abdominal discomfort due to torsion and de-torsion of the pedicle. Presentation of case We report a 35-year-old female presented with intermittent colicky abdominal pain that worsened in severity over three weeks. Diagnostic laparoscopy showed torsion of spleen without infarction. Detorsion and Splenopexy in an extra-peritoneal pouch was performed. Post operatively, the patient recovered well and was healthy at two months follow up. Discussion A wandering spleen is either congenital or acquired. The condition results in a long vascular pedicle, which predispose to the torsion resulting in a partial or complete infarct of the spleen. Laparoscopic approach is the preferred technique and de-torsion of the splenic pedicle and splenopexy is a reasonable surgical option, when there is no evidence of infarction of the spleen. Conclusion The diagnosis of wandering spleen is very rare and extremely difficult to establish and is clinically nonspecific. An early diagnosis and surgical care are required for preserving the spleen. Additional imaging examinations can help establish a diagnosis.
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Affiliation(s)
- Mariyem Awan
- Department of Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | - Jose Luis Gallego
- Department of Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | - Annett Al Hamadi
- Department of Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | - Vijay Chander Vinod
- Department of Accident & Emergency, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
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11
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Abstract
Wandering spleen is a rare entity that results from the absence or maldevelopment of the ligaments that support the spleen in its normal location. As a result, the spleen is hypermobile and may be predisposed to hilar torsion and subsequent infarction, making it a potentially fatal abdominal emergency. We present a case of a 36-year-old Afghan female who presented with an acute abdomen, and was radiologically and surgically confirmed to have a wandering spleen with torsion and complete infarction. Knowledge of this condition and its radiological findings can play a crucial role in making a correct and timely diagnosis.
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Affiliation(s)
- Dawar B Khan
- Department of Radiology, The Aga Khan University, Karachi, PAK
| | | | | | - Sarim D Khan
- Medical College, The Aga Khan University, Karachi, PAK
| | - Rabail Raza
- Department of Radiology, The Aga Khan University, Karachi, PAK
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Anand S, Yadav DK, Sharma S, Varshney A. Acute torsion of a wandering spleen: a paediatric emergency. BMJ Case Rep 2018; 2018:bcr-2018-225496. [PMID: 29950372 DOI: 10.1136/bcr-2018-225496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sachit Anand
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shilpa Sharma
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Abhimanyu Varshney
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Wandering spleen with horseshoe kidney a rare occurrence. Int J Surg Case Rep 2018; 45:96-100. [PMID: 29602063 PMCID: PMC6000907 DOI: 10.1016/j.ijscr.2018.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 01/05/2023] Open
Abstract
Wandering spleen with horseshoe kidney is a rare occurrence with less than 3 cases reported worldwide. Delay in diagnosis would result is increased mortality. Splenopexy is preferred in children with the exception of grossly infarcted spleen. Splenectomy is the treatment of choice in torsion of spleen with infarct.
Introduction Wandering spleen is a rare clinical entity in itself, with only 2 cases reported thus far when correlated with congenital under-development of the kidney, it usually happens due to under development of its surrounding ligaments. Herein we present a case of wandering spleen with underlying congenital deformity of horseshoe kidney which requires splenectomy due to late presentation. Presentation of case A 21 year old lady presented with worsening of chronic abdominal pain for 3 years, associated with nausea and vomiting. Physical examination showed a vague mass located at epigastric region. Consecutively, computed tomography images showed a well-defined, oval, hypoechoic spleen extending from center of abdomen up to epigastric region measuring 15.5 × 13 cm with twisted pedicle. Finally the patient underwent surgical treatment. The intraoperative findings were consistent with computed tomography images. The patient made a full recovery and was discharged well. Discussion Wandering Spleen was first described by Van Horne during autopsy back in 1667. Its location is maintained by peritoneal attachments such as lienorenal, splenocolic, splenophrenic, gastrosplenic and phrenicocolic ligaments. Among which, the gastrosplenic ligament and lienorenal ligaments are of greatest significance. Patient with a wandering spleen may present asymptomatic, with a movable mass in the abdomen, or with chronic or intermittent abdominal pain because of partial torsion and spontaneous de-torsion of the spleen as in our case. When feasible especially in young patients, splenopexy should always be the first consideration but however if gross infarct has occurred then splenectomy is inevitable to save the patient. Conclusion Wandering spleen is a unique surgical entity moreover when appeared in congruence with horseshoe kidney. Its diagnosis should be made in prompt to prevent splenic infarction and to try to salvage with splenopexy especially in younger population. However in patient where splenic torsion with infarction has occurred, splenectomy would be the treatment of choice.
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Abstract
Wandering spleen is a rare condition that accounts for less than 0.25% of all indications for splenectomy. It is characterized by ectopic localization of the spleen owing to the lack or weakening of its ligaments. Torsion is the most common complication due to its long pedicle and high mobility, which may result in acute abdomen. We report a case of torsion in a wandering spleen in a 28-year-old male presenting with an acute abdomen that was treated by splenectomy.
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Affiliation(s)
- Nwashilli N Jude
- Department of Surgery, University of Benin Teaching Hospital, Benin, Edo State, Nigeria. E-mail.
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15
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Abstract
Wandering spleen is a rare condition, typically not only due to embryological defects of the splenic ligaments, but also secondary to trauma and splenomegaly. The most common presentation is acute abdomen with a mobile abdominal mass or recurrent abdominal pain. However, the spleen may be temporary in its normal position, and patients could be asymptomatic. A familiarity, if present, strengthens the diagnostic suspect.Abdominal ultrasonography and computed tomography are the examination of choice, and the management is surgical.
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Makhlouf NA, Morsy KH, Ammar S, Mohammed RA, Yousef HA, Mostafa MG. Wandering spleen in the pelvic region in an adult man with symptoms of acute abdomen. Arab J Gastroenterol 2016; 17:49-52. [PMID: 27055928 DOI: 10.1016/j.ajg.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 06/05/2015] [Indexed: 12/20/2022]
Abstract
UNLABELLED Wandering or ectopic spleen is a condition characterised by migration of spleen in the abdomen or pelvis. This anomaly is rare, with a reported incidence of <0.2%. It occurs mostly in women between 20 and 40years of age. Clinical diagnosis is difficult because of lack of precise signs, symptoms, and nonspecific laboratory data. Diagnosis of a wandering spleen highly depends on the results of imaging studies such as abdominal ultrasound and abdominopelvic computed tomography (CT) scanning. Treatment includes surgery with the choice between splenopexy in a noninfarcted spleen and splenectomy when infarction has occurred. We report a rare case of wandering spleen in a 27-year-old man with infarction due to torsion of its pedicle, which was diagnosed by CT and treated by splenectomy. CONCLUSION Despite the rarity of wandering spleen, the possibility of torsion of its long pedicle with acute splenic infarction should be considered in the differential diagnosis of acute abdomen.
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Affiliation(s)
- Nahed A Makhlouf
- Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt
| | - Khairy H Morsy
- Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Sohag University, Egypt
| | - Samir Ammar
- Department of General Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt
| | - Radwan A Mohammed
- Department of General Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt
| | - Hazem A Yousef
- Department of Radiodiagnosis, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt
| | - Mohamed G Mostafa
- Department of Pathology, Assiut University Hospital, Faculty of Medicine, Assiut University, Egypt
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A Tuboovarian Abscess Associated with a Ruptured Spleen. Case Rep Emerg Med 2016; 2016:8796281. [PMID: 26904315 PMCID: PMC4745980 DOI: 10.1155/2016/8796281] [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: 10/16/2015] [Accepted: 12/27/2015] [Indexed: 11/29/2022] Open
Abstract
We report the first case of a tuboovarian abscess complicated by a ruptured spleen. Our patient was a 27-year-old female with human immunodeficiency virus (HIV) who presented to the emergency department (ED) with complaints of urinary symptoms and diarrhea. After being diagnosed with a tuboovarian abscess (TOA), she received antibiotics and was admitted to the gynecology service. Shortly thereafter she developed hemorrhagic shock, necessitating a splenectomy and salpingooophorectomy from a ruptured spleen.
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Richman M, Hiyama DT, Wasson E. Wandering spleen. Surgery 2014; 155:728. [DOI: 10.1016/j.surg.2012.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 11/16/2012] [Indexed: 11/29/2022]
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Sheikh F, Kim ME, Zamora IJ, Olutoye OO. Non-operative management of a rare diagnosis of splenic torsion in a child with a history of giant omphalocele: a case report and literature review. Patient Saf Surg 2014; 8:12. [PMID: 24602190 PMCID: PMC3973840 DOI: 10.1186/1754-9493-8-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Splenic torsion is rare and as a result the appropriate management is unclear. While there has been a shift towards splenectomy and laparoscopic splenopexy, we present a successful case of non-operative management of splenic torsion in a patient with a history of a giant omphalocele. CASE PRESENTATION A 3 year-old female presented with a three-day history of abdominal pain, fever and non-bloody emesis three and a half years after repair of her giant omphalocele. Abdominal radiographs and ultrasound demonstrated migration of the spleen and a subsequent computerized tomography scan confirmed splenic torsion and an infarcted spleen. Given her late presentation, she was successfully managed with observation, analgesia, immunization against capsulated organisms and daily penicillin prophylaxis with excellent outcome at 19 months follow-up. A review of the literature revealed that splenic torsion is rarely managed non-operatively. Rarer still is the occurrence of splenic torsion following a history of omphalocele. CONCLUSION Although rare, splenic torsion should be considered in a child with a history of omphalocele presenting with abdominal pain. Non-operative management of an infarcted spleen can be a safe treatment option to avoid surgery in complex patients.
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Affiliation(s)
| | | | | | - Oluyinka O Olutoye
- Division of Pediatric Surgery, Michael E DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston TX, USA.
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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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23
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El Bouhaddouti H, Lamrani J, Louchi A, El Yousfi M, Aqodad N, Ibrahimi A, Boubou M, Kamaoui I, Tizniti S. Torsion of a wandering spleen. Saudi J Gastroenterol 2010; 16:288-91. [PMID: 20871196 PMCID: PMC2995100 DOI: 10.4103/1319-3767.70618] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Wandering spleen is a rare condition defined as a mobile spleen only attached with its pedicle. It can be complicated by a volvulus, which is a surgical abdominal emergency. Preventing infarction is the aim of a prompt surgery that can preserve the spleen and then proceed to splenopexy. We report a rare case of torsion of a wandering spleen associated with a dolichosigmoοd.
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Affiliation(s)
| | - Jihane Lamrani
- Department of Digestive Surgery, University Hospital Hassan II Fes, Morocco
| | - Abdellatif Louchi
- Department of Digestive Surgery, University Hospital Hassan II Fes, Morocco
| | - Mounia El Yousfi
- Department of Gastroenterology, University Hospital Hassan II Fes, Morocco
| | - Noureddine Aqodad
- Department of Gastroenterology, University Hospital Hassan II Fes, Morocco
| | - Adil Ibrahimi
- Department of Gastroenterology, University Hospital Hassan II Fes, Morocco
| | - Meriem Boubou
- Department of Medical Imaging, University Hospital Hassan II Fes, Morocco
| | - Imane Kamaoui
- Department of Medical Imaging, University Hospital Hassan II Fes, Morocco
| | - Siham Tizniti
- Department of Medical Imaging, University Hospital Hassan II Fes, Morocco
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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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25
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Alshukry SM. Splenic torsion. Oman Med J 2008; 23:287-288. [PMID: 22334844 PMCID: PMC3273912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 09/15/2008] [Indexed: 05/31/2023] Open
Abstract
A young male presented with acute abdominal pain of 4 days. Treated as appendicular mass, which did not responds to conservative management. Ultra Sound scan and CT abdomen failed to give a definite diagnosis of the tender fixed mass in lower abdomen. Laparotomy proved the mass to be an engorged large spleen twisted on its long vascular pedicle, the ischemic spleen adherent to bowel loops and posterior peritoneum. Splenectomy performed. Postoperative reactionary hemorrhage required re-exploration and clearance of clots. Patient had uneventful recovery.
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Affiliation(s)
- Sabah Moosa Alshukry
- Address correspondence and reprint requests to: Dr. Sabah Moosa Alshukry, Senior Consultant Surgeon MBCHB, FRCS, Head of Department of Surgery, Rustaq Hospital, Sultanate of Oman. E-mail:
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