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K.S. S, Nikita N, Akash A, Bhandari G. Torsion of a Wandering Spleen Presenting as a Case of Acute Abdomen. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES 2022; 11:425-427. [DOI: 10.14260/jemds/2022/82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Wandering spleen is a rare clinical entity characterized by anomalous position of the spleen in the abdomen due to impaired splenic ligamentous attachments that produce an elongation of the vascular pedicle, favouring a possible volvulus of partial or complete vascular axis. Wandering spleen was first described in autopsies by Johannes Van Horne in 1667. Wandering spleen mainly presents as an asymptomatic mass or seldomly presents as recurrent abdominal pain or acute abdomen. The absence of splenic parenchyma in the left upper quadrant and ectopic location of the spleen can be shown by USG, CT and MRI The procedure of choice in the treatment of wandering spleen is splenopexy. Here we present a case of torsion in a wandering spleen in a 32 years old female. Wandering spleen is a rare clinical entity characterized by anomalous position of the spleen in the abdomen due to impaired splenic ligamentous attachments that produce an elongation of the vascular pedicle, favouring a possible volvulus of partial or complete vascular axis.1 Its aetiology is not clear. Congenital factors exist such as an alteration in the development of the dorsal mesogastrium2 and acquired factors such as hormonal changes during pregnancy,3 abdominal wall weakness, splenomegaly. Clinical presentation is variable, from asymptomatic to chronic abdominal pain or acute abdomen. The most common complication is acute torsion of the splenic pedicle causing acute abdominal pain.
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2
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ILGAR M, ÜNLÜ S, AKÇİÇEK M, DEMİRTAŞ G. An Unexpected Acute Abdomen Case: Torsion of a Wandering Spleen Treated with Splenopexy. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2020. [DOI: 10.33706/jemcr.811390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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3
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Torsion of a wandering spleen. Cir Esp 2019; 98:418-419. [PMID: 31679741 DOI: 10.1016/j.ciresp.2019.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/27/2019] [Accepted: 09/06/2019] [Indexed: 11/24/2022]
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4
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Rafie BA, AbuHamdan OJ, Trengganu NS, Althebyani BH, Almatrafi BS. Torsion of a wandering spleen as a cause of portal hypertension and mesenteric varices: a rare aetiology. J Surg Case Rep 2018; 2018:rjy107. [PMID: 29876050 PMCID: PMC5961426 DOI: 10.1093/jscr/rjy107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 01/02/2023] Open
Abstract
A wandering spleen is a condition characterized by excessive splenic mobility due to the mal-development or the laxity of its ligaments that leads to migration from its normal anatomical location. This condition renders its long mobile vascular pedicle liable to torsion and occasional infarction. Herein, we report a case of a 27-year-old nulliparous woman who presented with acute abdominal pain and a tender right-sided pelvi-abdominal mass. CT scan of the abdomen and pelvis revealed a torted, infarcted wandering spleen with portal hypertension and mesenteric varices that mandated an emergency splenectomy. Although there are a few reported cases describing the association of wandering spleen with portal hypertension and fundal varices, cases of mesenteric varices are extremely rare. To the best of our knowledge, this case is considered the third reported case of a wandering spleen which was subsequently complicated by portal hypertension and mesenteric varices that was managed effectively with splenectomy.
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Affiliation(s)
- Basmah A Rafie
- Department of General Surgery, Hera General Hospital, Makkah 21955, Kingdom of Saudi Arabia
| | - Omar J AbuHamdan
- Department of General Surgery, Hera General Hospital, Makkah 21955, Kingdom of Saudi Arabia
| | - Nawal S Trengganu
- Department of General Surgery, Hera General Hospital, Makkah 21955, Kingdom of Saudi Arabia
| | - Badr H Althebyani
- Department of Radiology, Hera General Hospital, Makkah 21955, Kingdom of Saudi Arabia
| | - Bassam S Almatrafi
- Department of Urology, King Abdullah Medical City, Makkah 21955, Kingdom of Saudi Arabia
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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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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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Köseoğlu H, Atalay R, Büyükaşık NŞ, Canyiğit M, Özer M, Solakoğlu T, Akın FE, Bolat AD, Yürekli ÖT, Ersoy O. An Unusual Reason for Gastric Variceal Hemorrhage: Wandering Spleen. Indian J Surg 2013; 77:750-1. [PMID: 26730110 DOI: 10.1007/s12262-013-0993-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 10/07/2013] [Indexed: 12/20/2022] Open
Abstract
Wandering spleen is the displacement of the spleen due to the loss or weakening of the ligaments of the spleen and is seen very rarely with an incidence of less than 0.5 %. It can cause portal hypertension, but gastric variceal hemorrhage is a quite rare condition within the spectrum of this uncommon disease. We report a 22-year-old woman with wandering spleen presenting with life-threatening gastric variceal hemorrhage. Her diagnosis was made by computerized tomography. Endoscopic therapy was not adequate to stop the bleeding, and urgent splenectomy was performed. After surgery she has been well with no symptoms until now.
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Affiliation(s)
- Hüseyin Köseoğlu
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Roni Atalay
- Department of Gastroenterology, Ankara Ataturk Research and Education Hospital, Ankara, Turkey
| | - Naciye Şemnur Büyükaşık
- Department of Gastroenterology, Ankara Ataturk Research and Education Hospital, Ankara, Turkey
| | - Murat Canyiğit
- Department of Radiology, Ankara Ataturk Research and Education Hospital, Ankara, Turkey
| | - Mehmet Özer
- Department of General Surgery, Ankara Ataturk Research and Education Hospital, Ankara, Turkey
| | - Tevfik Solakoğlu
- Department of Gastroenterology, Ankara Ataturk Research and Education Hospital, Ankara, Turkey
| | - Fatma Ebru Akın
- Department of Gastroenterology, Ankara Ataturk Research and Education Hospital, Ankara, Turkey
| | - Aylin Demirezer Bolat
- Department of Gastroenterology, Ankara Ataturk Research and Education Hospital, Ankara, Turkey
| | - Öykü Tayfur Yürekli
- Department of Gastroenterology, Ankara Ataturk Research and Education Hospital, Ankara, Turkey
| | - Osman Ersoy
- Department of Gastroenterology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Yılmaz Ö, Bayrak V, Daştan E, Kotan Ç. Torsion of wandering spleen as a rare reason for acute abdomen: A presentation of two cases. ULUSAL CERRAHI DERGISI 2013; 29:200-2. [PMID: 25931877 DOI: 10.5152/ucd.2013.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 03/04/2013] [Indexed: 11/22/2022]
Abstract
Wandering spleen is a rare disease that is clinically characterized by torsion of the pedicle. The congenital absence of ligaments anchoring the spleen to the left sub-phrenic area or an acquired looseness is the major reason behind its mobilization. Unless splenic torsion occurs and acute abdominal clinical symptomatology develops, clinical diagnosis is highly challenging due to lack of symptoms. This study aims to share the information acquired from two encountered cases accompanied by the relevant literature.
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Affiliation(s)
- Özkan Yılmaz
- Department of General Surgery, Ersin Arslan State Hospital, Gaziantep, Turkey
| | - Vedat Bayrak
- Department of General Surgery, Ceyhan State Hospital, Adana, Turkey
| | - Ertuğrul Daştan
- Department of General Surgery, Bitlis State Hospital, Bitlis, Turkey
| | - Çetin Kotan
- Department of General Surgery, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
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Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med 2012; 12:11. [PMID: 22889306 PMCID: PMC3532171 DOI: 10.1186/1471-227x-12-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. METHODS Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. RESULTS We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. CONCLUSIONS Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.
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Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
| | - Nicholas Sowers
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Fonseca AZ, Ribeiro M, Contrucci O. Torsion of a wandering spleen treated with partial splenectomy and splenopexy. J Emerg Med 2012; 44:e33-6. [PMID: 22381612 DOI: 10.1016/j.jemermed.2011.06.146] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 05/06/2011] [Accepted: 06/11/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Wandering spleen is a rare and unusual entity, characterized by excessive mobility and displacement of the organ from its normal position. This happens due to congenital or acquired anomalies leading to the lack of the spleen's suspensory ligaments. Clinical presentation is variable; acute abdominal pain may occur when persistent torsion of the splenic pedicle results in splenic infarction. Ultrasonography, computed tomography, and magnetic resonance imaging are modalities that may be used in diagnosis. The treatment of choice is surgery, with splenectomy or splenopexy, the latter being preferred. CASE REPORT The patient was a 38-year-old woman with a 10-day history of left-sided abdominal pain. Imaging demonstrated a wandering spleen with partial infarction of the inferior pole. An open partial splenectomy with splenopexy of the remaining spleen was performed with the use of an absorbable mesh sutured to the abdominal wall and stomach. Her recovery was uneventful and on follow-up she had no signs of recurrence or complications. CONCLUSION Wandering spleen should be considered in cases of acute abdominal pain, and surgery is the treatment of choice, with the goal of preservation of the organ whenever possible.
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11
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Torsión esplénica en paciente con bazo ectópico. Cir Esp 2012; 90:126-7. [DOI: 10.1016/j.ciresp.2010.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 10/06/2010] [Accepted: 10/07/2010] [Indexed: 11/18/2022]
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12
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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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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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Soleimani M, Mehrabi A, Kashfi A, Fonouni H, Büchler MW, Kraus TW. Surgical Treatment of Patients with Wandering Spleen: Report of Six Cases with a review of the literature. Surg Today 2007; 37:261-9. [PMID: 17342372 DOI: 10.1007/s00595-006-3389-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 07/25/2006] [Indexed: 12/19/2022]
Abstract
Wandering spleen, which is defined as a spleen without peritoneal attachments, is a rare disease and a delay in the clinical and/or radiological diagnosis may lead to splenic torsion, infarction, and necrosis. Owing to the physiologic importance of the spleen, especially in children, and the risk of postsplenectomy sepsis, early diagnosis and splenopexy are recommended. In the present article, we describe the results of our management of this rare problem on six patients, and we review all available literature from 1895 to 2005. Briefly, our technique includes flap creation from parietal peritoneum and settlement of spleen in the fossa splenica. Free edges of this flap are stitched to the stomach and the left end of transverse colon and the beginning of the descending colon. The body of the stomach was stitched to the abdominal wall to prevent gastric volvulus, while the fundus region was fixed to the diaphragm to support the spleen. Finally, an omental patch was stitched to the intact abdominal wall above the flap. In conclusion, the procedure of splenopexy without using mesh is considered to be a safe and curative modality for wandering spleen without imposing any undue risk of infection or foreign material reaction.
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Castellón-Pavón CJ, Valderrábano-González S, Anchústegui-Melgarejo P, Alvarez-Alvarez J, Morales-Artero S, Pérez-Algar C, Corrales-Castillo S, García-Serrano FR. Esplenectomía laparoscópica por torsión de un bazo ectópico (wandering spleen). Cir Esp 2006; 80:406-8. [PMID: 17192227 DOI: 10.1016/s0009-739x(06)70996-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Wandering spleen is an uncommon entity, characterized by the anomalous position of the spleen, caused by the absence or laxity of its suspensory ligaments. The most common symptoms are usually due to intermittent or complete torsion of the splenic pedicle with subsequent infarction. We report a case of torsion of a wandering spleen. Laparoscopic splenectomy was performed and recovery was uneventful. Although few cases of wandering spleen treated laparoscopically have been reported in the literature, laparoscopy has been demonstrated to be a safe technique for the treatment of this entity.
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