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French J, Austin CL, Sodade FE, Beam ZT. Wandering Spleen in a Patient With Significant Medical History. Cureus 2023; 15:e35543. [PMID: 37007360 PMCID: PMC10056767 DOI: 10.7759/cureus.35543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
The clinical presentation of a wandering spleen is characterized mainly by unspecific acute symptoms, ranging from diffuse abdominal pain to left upper/lower quadrant and referred shoulder pain to asymptomatic. This has challenged accelerated medical care and impeded the acquisition of confirmatory diagnosis; therefore, increasing morbidity and mortality risks. Splenectomy is an established operative procedure for a wandering spleen. However, there has not been enough literature emphasizing the clinical history of congenital malformations and surgical corrections as inferential tools for facilitating a decisive and informed procedure. The case presented is of a 22-year-old female who reported to the emergency department with a five-day persistent left upper quadrant and left lower quadrant (LLQ) abdominal pain, associated with nausea. According to the medical history, the patient had a significant history of vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula, renal anomalies, and limb abnormalities (VACTERL) associated with congenital anomalies. By the age of eight years, the patient had undergone multiple surgical interventions, including tetralogy of Fallot repair, an imperforate anal repair with rectal pull-through, Malone antegrade continence enema (MACE), and bowel vaginoplasty. Computed tomography imaging of the abdomen revealed evidence of a wandering spleen in the LLQ with associated torsion of the splenic vasculature (whirl sign). Intra-operatively, appendicostomy was identified extending from the cecum in a near mid-line position, to the umbilicus, and carefully incised distally, preventing injury to the appendicostomy. The spleen was identified in the pelvis, and the individual vessels were clamped, divided, and ligated. Blood loss was minimal with no post-operative complications. This rare case report adds valuable teaching points about the treatment of wandering spleen in individuals with VACTERL anomalies.
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Ouazzani LCE, Jadib A, Siradji H, Wassi AE, Boutachali R, Tabakh H, Siwane A, Touil N, Kacimi O, Chikhaoui N. Splenic volvulus on ectopic spleen in adults: A case report. Radiol Case Rep 2022; 17:2167-2169. [PMID: 35479965 PMCID: PMC9036056 DOI: 10.1016/j.radcr.2022.03.045] [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: 03/02/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 11/28/2022] Open
Abstract
Ectopic spleen is a rare clinical entity characterized by splenic hypermobility which may be congenital or acquired. The spleen may be migrated to different positions in the peritoneum. The main complication is pedicular torsion with splenic volvulus, presenting as an emergency abdominal surgery. We present and discuss a case of ectopic and twisted spleen resulting in complete splenic infarction, diagnosed by ultrasound, confirmed by CT scan and treated by splenectomy.
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Thomas AK, Thomas R. The likely association between wandering spleen and absent left kidney. Emerg Radiol 2021; 28:431-435. [PMID: 33417114 DOI: 10.1007/s10140-020-01895-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
Wandering spleen is a cause of acute surgical abdomen with serious consequences. It arises from an absence or weakness of the supporting suspensory splenic ligaments. There is often a delayed diagnosis due to its non-specific clinical presentation. This leads to stalled acquisition of confirmatory diagnostic imaging with resultant increased morbidity and mortality. Congenital or acquired absence of the left kidney results in loss of the splenorenal ligament, a key ligament to maintain normal splenic position in the abdomen. Two patients, one with OHVIRA (obstructed hemivagina ipsilateral renal anomaly) syndrome and another who underwent a left nephrectomy during infancy, developed a wandering spleen with acute splenic torsion in the setting of an absent left kidney. This case series aims to increase awareness to the likely predisposition for individuals with an absent left kidney to develop a wandering spleen.
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Affiliation(s)
- Anna Kalathil Thomas
- University of Tennessee Health Science Center, LeBonheur Children's Hospital, 848 Adams Ave. G216, TN, 38103, Memphis, USA.
| | - Rebecca Thomas
- Southern Adventist University, 4881 Taylor Cir, Collegedale, TN, 37315, USA
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Chang YL, Lin J, Li YH, Tsao LC. Unusual association of Axenfeld-Rieger syndrome and wandering spleen: A case report. World J Clin Cases 2020; 8:1502-1506. [PMID: 32368543 PMCID: PMC7190964 DOI: 10.12998/wjcc.v8.i8.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Axenfeld-Rieger syndrome (ARS) is an autosomal dominant genetic disease characterized by ocular developmental disorders and its association with torsion of wandering spleen (WS) has not been reported to date to the best of our knowledge. This study aimed to describe a rare case of ARS observed at our emergency department.
CASE SUMMARY A 25-year-old female presented with a constant lower abdominal pain of increasing severity. Diagnostic computed tomography with intravenous contrast material showed a non-homogenously enhanced splenic parenchyma with a twisted vascular pedicle. Further, an emergent laparoscopic exploration was performed, and an ischemic spleen without its normal ligamentous attachments was noted. Notably, the spleen did not regain its normal vascularity after detorsion; thus, we performed the laparoscopic total splenectomy. The postoperative course was uneventful, and the patient was discharged on the 5th postoperative day. This case demonstrates a rare association of WS and ARS.
CONCLUSION Early diagnosis of WS in the emergency department is important to prevent pedicle torsion or splenic necrosis and to avoid splenectomy.
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Affiliation(s)
- Yi-Lin Chang
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Joseph Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Yu-Hsien Li
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Lien-Cheng Tsao
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
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Cetinoglu YK, Karasu S, Acar T, Uluc ME, Haciyanli M, Tosun O. Torsion of Wandering Spleen: Importance of Splenic Density and Liver-to- Spleen Attenuation Ratio on CT. Curr Med Imaging 2020; 16:88-93. [PMID: 31989898 DOI: 10.2174/1573405614666181009142322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/19/2018] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Wandering spleen (WS) is a rare clinical condition which may cause fatal complication like torsion with subsequent infarction. Determination of splenic parenchyma viability is very important in deciding whether splenopexy rather than splenectomy is an option. Contrast- enhanced computed tomography (CECT) is important for the diagnosis of WS and assessment of the viability of spleen. DISCUSSION We reviewed the CT studies of four cases with WS. We measured the mean splenic and liver density and calculated liver-to-spleen attenuation ratio (LSAR). We also assessed the CT findings for each patient. Mean splenic density was measured as 40.77 Hounsfield Unit (HU) in cases with infarction, 127.1 HU in case without infarction. LSAR was calculated as 2.55 in cases with infarction, 0.99 in case without infarction. We detected whirlpool sign, intraperitoneal free fluid, splenic arterial enhancement in all patient, parenchymal and splenic vein enhancement in one patient without infarction, fat rim sign in three patients with infarction, capsular rim sign in one patient with infarction. CONCLUSION CECT should be obtained for the diagnosis of WS and assessment of the viability of spleen. CECT could suggest the diagnosis of infarction of the spleen with following findings; absence of parenchymal enhancement, very low density of spleen (<45 HU), and LSAR which is greater than 2.
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Affiliation(s)
- Yusuf Kenan Cetinoglu
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Sebnem Karasu
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Turan Acar
- Department of General Surgery, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Muhsin Engin Uluc
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Mehmet Haciyanli
- Department of General Surgery, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Ozgur Tosun
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
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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: 8] [Impact Index Per Article: 1.3] [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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7
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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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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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Masui D, Fukahori S, Asagiri K, Ishii S, Saikusa N, Hashizume N, Yoshida M, Higasidate N, Sakamoto S, Tsuruhisa S, Tanaka Y, Yagi M. Wandering spleen associated with omphalocele in a neonate: An unusual case with non-operative management. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Dème H, Akpo LG, Fall S, Badji N, Ka I, Guèye ML, Touré MH, Niang EH. [Torsion of wandering spleen in a teenager: about a case]. Pan Afr Med J 2016; 24:15. [PMID: 27583079 PMCID: PMC4992398 DOI: 10.11604/pamj.2016.24.15.7554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/18/2015] [Indexed: 11/11/2022] Open
Abstract
Wandering or migrating spleen is a rare anomaly which is usually described in children. Complications, which include pedicle torsion, are common and can be life-threatening. We report the case of a 17 year-old patient with a long past medical history of epigastric pain suffering from wandering spleen with chronic torsion of the pedicle. The clinical picture was marked by spontaneously painful epigastric mass, evolved over the past 48 hours. Abdominal ultrasound objectified heterogeneous hypertrophied ectopic spleen in epigastric position and a subcapsular hematoma. Doppler showed a torsion of splenic pedicle which was untwisted 2 turns and a small blood stream on the splenic artery. Abdominal CT scan with contrast injection showed a lack of parenchymal enhancement of large epigastric ectopic spleen and a subcapsular hematoma. The diagnosis of wandering spleen with chronic torsion of the pedicle complicated by necrosis and subcapsular hematoma was confirmed. The patient underwent splenectomy. The postoperative course was uneventful. We here discuss the contribution of ultrasound and CT scan in the diagnosis of wandering spleen with chronic torsion of the pedicle.
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Affiliation(s)
- Hamidou Dème
- Service de Radiologie et Imagerie Médicale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Léra Géraud Akpo
- Service de Radiologie et Imagerie Médicale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Seynabou Fall
- Service de Médecine Interne, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Nfally Badji
- Service de Radiologie et Imagerie Médicale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Ibrahima Ka
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
| | | | | | - El Hadj Niang
- Service de Radiologie et Imagerie Médicale, CHU Aristide Le Dantec, Dakar, Sénégal
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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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12
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Gorsi U, Bhatia A, Gupta R, Bharathi S, Khandelwal N. Pancreatic volvulus with wandering spleen and gastric volvulus: an unusual triad for acute abdomen in a surgical emergency. Saudi J Gastroenterol 2014; 20:195-8. [PMID: 24976284 PMCID: PMC4067917 DOI: 10.4103/1319-3767.133026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Wandering spleen is a rare clinical condition which occurs due to laxity or absence of the normal intraperitoneal ligaments that hold the spleen in place. Gastric volvulus and wandering spleen share a common etiology of absence or laxity of intraperitoneal ligaments. The occurrence of simultaneous pancreatic volvulus has never been described before in adolescence. Herein, we report a case having wandering spleen with torsion, and gastric and distal pancreatic volvulus, an unusual triad in acute abdomen in an emergency setting, which has never been described before to the best of our knowledge.
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Affiliation(s)
- Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Ujjwal Gorsi, Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012, India. E-mail:
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saranga Bharathi
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Samarasinghe RN, Protyniak B, Bethel CA. Wandering spleen and splenic torsion associated with upper respiratory tract infection. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Mehta A, Vana PG, Glynn L. Splenic torsion after congenital diaphragmatic hernia repair: case report and review of the literature. J Pediatr Surg 2013; 48:e29-31. [PMID: 23480945 DOI: 10.1016/j.jpedsurg.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
Wandering spleen with torsion, a rare clinical diagnosis, was found to be the cause of chronic abdominal pain in an 11-year-old female with a history of congenital diaphragmatic hernia repaired at three days of age. Doppler ultrasound revealed patent vessels with splenomegaly, and computed tomography (CT) showed an absence of the spleen in the left subphrenic space with torsion at the splenic hilum. Due to the chronicity of pain and risk of ischemia from torsion, open splenopexy with Vicryl mesh was performed. This case report/review of the literature discusses the rarity of this condition, and the importance of timely diagnosis and intervention.
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Affiliation(s)
- Anupama Mehta
- Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
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Le K, Griner D, Hope WW, Tackett D. Splenic torsion requiring splenectomy six years following laparoscopic Nissen fundoplication. JSLS 2012; 16:184-8. [PMID: 22906354 PMCID: PMC3407447 DOI: 10.4293/108680812x13291597716861] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Laparoscopic Nissen fundoplication has become a mainstay in the surgical treatment of gastroesophageal reflux disease, as it has proved to be a durable, well-tolerated procedure. Despite the safety and efficacy associated with this procedure, surgeons performing this advanced laparoscopic surgery should be well versed in the potential intraoperative and postoperative complications. METHODS A case is presented of a rare complication of splenic torsion following laparoscopic Nissen fundoplication. Diagnostic evaluations and intraoperative findings are discussed. RESULTS We present an otherwise healthy 41-year-old woman who underwent a laparoscopic Nissen fundoplication 6 years earlier at another medical center and presented with worsening chronic left upper quadrant abdominal pain. She was diagnosed with torsion of the splenic vascular pedicle, resulting in heterogenicity of perfusion with associated hematoma requiring open splenectomy. CONCLUSION Surgeons should be aware of splenic torsion as a potential, albeit rare, complication related to laparoscopic Nissen fundoplication.
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Affiliation(s)
- Khoi Le
- South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA
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16
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Laparoscopic splenectomy for the treatment of wandering spleen in a pregnant woman: a case report. Surg Laparosc Endosc Percutan Tech 2012; 22:e102-4. [PMID: 22487633 DOI: 10.1097/sle.0b013e318246beb5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Laparoscopic splenectomy became the gold standard recently for the removal of spleen. One of its rare indication is wandering spleen (WS). WS is characterized by incomplete fixation of the spleen. Patients usually have an asymptomatic abdominal mass. When they are symptomatic, abdominal pain with a mobile mass is the major finding. Laboratory data are nonspecific, but the diagnosis can be confirmed by imaging studies; computed tomography, magnetic resonance imaging, and ultrasonography are preferred modalities. It can predispose one to life-threatening complications such as splenic infarction, portal hypertension, pancretitis, and hemorrhage, due to torsion of its vascular pedicle. Herein, we present a female patient, a 24-year-old, 18-week primigravida. She was admitted with an intra-abdominal mass and lower abdominal pain. Ultrasonography revealed a mass behind the uterus. Magnetic resonance imaging was planned, and the spleen was seen at this area. We performed laparoscopic splenectomy for the treatment of a WS, which would be dangerous for pregnancy. The patient was discharged without any postoperative complication on the third day postoperatively. A healthy baby was delivered at term. Minimally invasive procedures should also be the primary choice in the treatment of such pregnant women. This is the first case of laparoscopic splenectomy in a pregnant woman for WS in the English literature.
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17
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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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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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Abstract
Wandering spleen is a rare condition that can lead to splenic infarction or rupture if torsion persists. Early diagnosis and intervention are necessary, and abdominal ultrasonography and abdominal computed tomography are well accepted as the diagnostic imaging modalities. In this study, we present a boy with nic infarction due to acute torsion of a wandering spleen, after initial failure to demonstrate an ectopic spleen. Instead, acute torsion of the wandering spleen with spontaneous partial detorsion was incidentally found by multi-detector row CT with angiography. The patient was managed by splenectomy instead of splenopexy, because poor reperfusion after Laparoscopic detorsion.
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Affiliation(s)
- Chi-Hone Lien
- Department of Pediatrics, Mackay Memorial Hospital, Hsin Chu Branch, Taiwan
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Di Crosta I, Inserra A, Gil CP, Pisani M, Ponticelli A. Abdominal pain and wandering spleen in young children: the importance of an early diagnosis. J Pediatr Surg 2009; 44:1446-9. [PMID: 19573677 DOI: 10.1016/j.jpedsurg.2009.02.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 01/27/2009] [Accepted: 02/28/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study is to increase clinical awareness of torsion of wandering spleen (WS) in childhood and the need of a rapid diagnosis. METHODS Four cases operated for torsion of WS are retrospectively reviewed. Ages at presentation were, respectively, 30 months, 5 years, 4 years, and 3 years, without sex preference. All subjects led a history of abdominal pain and a mass on physical examination. RESULTS Torsion of WS should be suspected in any child presenting with acute abdomen. Moreover, in case of acute abdomen and intermittent abdominal pain, we suggest studying spleen position with ultrasound. CONCLUSIONS Ultrasonography with color Doppler is the best choice for diagnosis of torsion of WS. Computed tomography is a good complementary examination, but it needs to submit young patients to a general anesthesia and delays an emergency situation.
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Affiliation(s)
- Ida Di Crosta
- Department of Pediatric Surgery, University Hospital Joan XXIII, 43007, Tarragona, Spain.
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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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Sodhi KS, Gupta P, Rao KLN, Marwaha RK, Khandelwal N. Marfanoid hypermobility syndrome and skeletal abnormalities in a rare case of torsion of wandering spleen. Br J Radiol 2008; 81:e145-8. [PMID: 18440937 DOI: 10.1259/bjr/30123041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Wandering spleen is a rare clinical entity characterized by splenic hypermobility resulting from laxity or maldevelopment of supporting splenic ligaments. Its major complication is splenic torsion, which is a potentially fatal surgical emergency. We present a rare case of wandering spleen with torsion and splenic infarction in a patient with marfanoid hypermobility syndrome and vertebral abnormalities.
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Affiliation(s)
- K S Sodhi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India.
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Laparoscopic treatment of a wandering spleen causing partial colonic obstruction: report of a case. Surg Laparosc Endosc Percutan Tech 2008; 17:462-4. [PMID: 18049417 DOI: 10.1097/sle.0b013e3180ca9b54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Wandering spleens are rarely encountered ectopic localizations of the spleen. They are either congenital or acquired owing to the lack of or weakening of the major splenic ligaments. Herein, we present a female patient who was admitted to our hospital with the complaint of abdominal distension and chronic constipation. We performed laparoscopic splenectomy in this case for the diagnosis of a wandering spleen located in the right upper quadrant. The accepted treatment of this pathology is splenopexy unless there is no necrosis of the organ. Minimal invasive procedures should be the primary choice in the treatment of this entity.
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Lacreuse I, Moog R, Kauffmann I, Méfat L, Bailey C, Becmeur F. Laparoscopic splenopexy for a wandering spleen in a child. J Laparoendosc Adv Surg Tech A 2007; 17:255-7. [PMID: 17484662 DOI: 10.1089/lap.2006.0005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We present a case of acute volvulus of a wandering spleen in a 5-year-old girl that was diagnosed preoperatively by computed tomography scan and which we treated with a laparoscopic splenopexy on an emergent basis.
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Affiliation(s)
- Isabelle Lacreuse
- Department of Pediatric Surgery, Hôpitaux Universaires de Strasbourg, Université Louis Pasteur, Hôpital de Hautepierre, Strasbourg, France.
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Mendi R, Abramson LP, Pillai SB, Rigsby CK. Evolution of the CT imaging findings of accessory spleen infarction. Pediatr Radiol 2006; 36:1319-22. [PMID: 17016699 DOI: 10.1007/s00247-006-0323-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 08/18/2006] [Accepted: 08/24/2006] [Indexed: 10/24/2022]
Abstract
We report the case of a 12-year-old girl presenting with multiple episodes of left upper-quadrant pain caused by torsion of an accessory spleen.We present the CT findings of progression of accessory spleen infarction over the course of 7 days.
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Affiliation(s)
- Resham Mendi
- Department of Medical Imaging, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA
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Esposito C, Settimi A, Centonze A, Damiano R, Maglio P, Esposito G. Enlarged wandering spleen treated with hemisplenectomy and fixation of the residual spleen. Pediatr Surg Int 2005; 21:488-90. [PMID: 15803335 DOI: 10.1007/s00383-005-1403-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2004] [Indexed: 10/25/2022]
Abstract
A case of enlarged wandering spleen presenting as an abdominal mass in a 7-year-old girl is reported. The diagnosis was performed by ultrasonography and confirmed by aortography. Treatment consisted of an elective partial splenectomy and fixation of the residual spleen to the left hemidiaphragm. The patient's symptoms regressed, and now, after more than 2 years, she is doing well. Two years postoperatively scintigraphy demonstrated a good captation of radionuclide by a normal-sized spleen at the left hypochondrium. The results obtained with the procedure that was adopted for treating this case of wandering spleen allow the authors to state that hemispleen fixation is a valid option for treating symptomatic enlarged wandering spleen.
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Affiliation(s)
- C Esposito
- Pediatric Surgery, Department of Experimental and Clinical Medicine, Magna Graecia University, Via Tommaso Campanella 115, 88100 Catanzaro, Italy.
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Abstract
OBJECTIVE To describe the clinical signs, diagnostic evaluation and surgical management of an alpaca with splenic torsion. ANIMALS Six-year-old female alpaca. RESULTS Splenic torsion and uterine torsion were the inciting cause for persistent abdominal discomfort in this alpaca. Rectal examination, abdominocentesis, and transabdominal ultrasonographic findings were suggestive of a splenic lesion. Surgical management involved splenectomy of a necrotized spleen. CONCLUSIONS Although rare in occurrence, splenic torsion should be considered as a potential cause of abdominal discomfort in alpacas. Splenectomy is a reasonable and successful method of treatment for a devitalized spleen secondary to splenic torsion in alpacas. CLINICAL RELEVANCE Splenic torsion causes persistent abdominal discomfort in camelids and may be associated with uterine torsion. Rectal examination, transabdominal ultrasound and abdominocentesis are useful diagnostic tools to differentiate splenic torsion from other causes of abdominal discomfort. Splenectomy is an uncomplicated procedure in camelids and has a favorable prognosis.
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Affiliation(s)
- Jennifer J Smith
- Department of Clinical Studies, University of Pennsylvania, New Bolton Center, Kennett Square, PA 19348, USA.
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