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Ahmed S, Iqbal S, Batool S, Khan R. Splenic torsion mistaken for an ovarian cyst: a case report. J Med Case Rep 2024; 18:181. [PMID: 38615066 PMCID: PMC11016203 DOI: 10.1186/s13256-024-04502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/10/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed. CASE PRESENTATION A 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days. CONCLUSION Splenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.
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Affiliation(s)
- Salaar Ahmed
- Medical College, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
| | - Shahid Iqbal
- Medical College, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Shariqa Batool
- Medical College, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Rizwan Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
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2
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Salvador L, Agaba L, Mukisa B, Amone J, Odaga J. Wandering spleen: An unsuspected presentation at a general hospital in Uganda. Int J Surg Case Rep 2023; 102:107863. [PMID: 36608635 PMCID: PMC9826802 DOI: 10.1016/j.ijscr.2022.107863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/26/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Wandering spleen is an uncommon condition marked by splenic hypermobility due to laxity or underdevelopment of the supporting splenic ligaments. Patients may be asymptomatic, have a palpable mass in the abdomen, or exhibit acute, long-lasting, or sporadic symptoms as a result of the spleen's pedicle torsion. The management should be determined by the spleen's vitality. CASE PRESENTATION We report a case of a 29-year-old male who presented with a 5-year history of progressive abdominal swelling, surgically managed as an intrabdominal tumor at a general hospital in Uganda, with a postoperative confirmation of a wandering spleen. CLINICAL DISCUSSION Wandering spleen is a rare condition both in high- and low-income countries. Clinical presentations vary from an asymptomatic abdominal mass to acute abdominal pain due to vascular pedicle torsion leading to splenic infarction. When possible, splenopexy is the procedure of choice, especially in children and in tropical countries, to avoid post-splenectomy sepsis. Splenectomy is the definitive treatment for spleen fracture, spleen infarction, or symptoms that recur after splenopexy. CONCLUSION Wandering spleen is a rare differential diagnosis of intrabdominal tumor that must be considered in patients with a palpable abdominal mass with or without acute or chronic abdominal pain. Though a CT scan is the best method to confirm the diagnosis, the radiologist's and surgeon's experience and keenness seem very vital in making the correct diagnosis. Intraoperative complete abdominal exploration by the surgeon is essential to confirm the radiological findings, to enhance the diagnosis, and to make the best treatment decision.
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Affiliation(s)
- Luca Salvador
- Operational Research Unit, Doctors with Africa CUAMM Uganda, P.O. BOX 7214, Kampala, Uganda,Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy,Corresponding author at: Operational Research Unit, Doctors with Africa CUAMM Uganda, P.O. BOX 7214, Kampala, Uganda.
| | - Lino Agaba
- St. John's XXIII Hospital Aber, Jaber 21310, Uganda
| | | | - James Amone
- St. John's XXIII Hospital Aber, Jaber 21310, Uganda
| | - Jimmy Odaga
- Operational Research Unit, Doctors with Africa CUAMM Uganda, P.O. BOX 7214, Kampala, Uganda,St. John's XXIII Hospital Aber, Jaber 21310, Uganda
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3
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Ahmed M, Nasir M, Negash A, Haile K. Wandering Spleen with Splenic Torsion: Unusual Cause of Acute Abdomen. Int Med Case Rep J 2022; 15:625-630. [PMID: 36388241 PMCID: PMC9642092 DOI: 10.2147/imcrj.s388271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/26/2022] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Wandering spleen is a rare condition characterised by laxity or lack of splenic ligaments as a result of acquired or congenital causes. There is a possibility of misdiagnosis due to its vague symptoms. In order to make a proper diagnosis, imaging techniques including abdominal ultrasonography and CT scanning are essential. Surgery is the main option of management. If the spleen is viable and there is no thrombosis in the splenic veins, splenopexy is the preferred surgical procedure. Alternatively, splenectomy plus prophylactic antibiotic and vaccination usage may be employed if spleen has infarction. CASE PRESENTATION A 12-year-old male child who had previously experienced constipation, mucoid diarrhoea, and abdominal distention arrived with crampy abdominal pain that had lasted for four days. The patient was tachycardic with abdominal tenderness. Whirlpool sign and lack of a spleen in its normal position were visualized on an abdominal ultrasound. The spleen was located intraoperatively in the lower abdomen, adhered to the ileum and appendix. It was 720° twisted and had necrotic areas. The patient underwent an appendectomy with splenectomy with a smooth post-operative course; combination meningococcal and pneumococcal vaccines were administered; and antibiotic prophylaxis was started for the patient. CONCLUSION High clinical suspicion and the use of imaging modalities like ultrasound and CT scan are extremely crucial to diagnose wandering spleen and perform splenic salvage surgery because its clinical diagnosis is challenging.
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Affiliation(s)
- Muluken Ahmed
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
| | - Mohammed Nasir
- Pediatrics Department, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ashenafi Negash
- Surgery Department, Arba Minch University, Arba Minch, Ethiopia
| | - Kidist Haile
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
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4
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Surgical Management of a Volvulus of a Wandering Spleen Associated with a Volvulus of the Small Intestine. Case Rep Surg 2022; 2022:8696492. [PMID: 35492869 PMCID: PMC9054486 DOI: 10.1155/2022/8696492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction A wandering spleen is a rare anatomical condition characterized by a free-floating splenic tissue that is not located in its normal position in the left upper quadrant. This condition is usually asymptomatic but can also manifest itself with volvulus of the spleen and consequent infarction and necrosis of the parenchyma, requiring an urgent surgical management. Additionally, a wandering spleen can be associated with other contemporaneous anatomical anomalies. Case Presentation. We report a case of a 21-year-old woman, admitted to our hospital for intense abdominal pain and vomiting. A CT scan revealed a wandering spleen in the mesogastric area with the spleen torted on its axis, associated with a volvulus of the small intestine. Abdominal exploration revealed a macroscopically normal free-floating spleen attached to an abnormally long vascular pedicle. The management of the wandering spleen was conservative, and a splenopexy was performed. Conclusions The torsion of the wandering spleen constitutes an infrequent but life-threatening abdominal emergency. The diagnosis of the wandering spleen is frequently challenging since clinical findings are usually not specific. Imaging such as computed tomography scan plays an important role in the differential diagnosis pathway. Treatment should be planned according to the splenic parenchyma conditions. Splenectomy is indicated when massive infarction and thrombosis of splenic vessels have occurred. When splenic parenchyma is not compromised, it is preferred to perform a conservative surgical technique, such as splenopexy, in order to avoid postsplenectomy complications.
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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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6
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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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7
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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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Asafu Adjaye Frimpong G, Aboagye E, Ayisi-Boateng NK, Antwi K, Bawuah KA, Coleman NE, Nunoo AW, Danso DB, Amoah M, Kwofie B. Concurrent occurrence of a wandering spleen, organoaxial gastric volvulus, pancreatic volvulus, and cholestasis - A rare cause of an acute abdomen. Radiol Case Rep 2019; 14:946-951. [PMID: 31193859 PMCID: PMC6543132 DOI: 10.1016/j.radcr.2019.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
The concurrence of wandering spleen, organoaxial gastric volvulus, and pancreatic volvulus is very rare. They have been associated with symptoms such as severe abdominal pain, abdominal distention, and vomiting. However, the diagnosis remains complicated and any delay can result in ischemia and necrosis of the organs involved. In this case presentation, we present a unique case involving a 14-year-old girl who presented initially with acute abdominal pain. Assessment with enhanced computed tomography scan led to the diagnosis of wandering spleen, organoaxial gastric volvulus, and pancreatic volvulus, in addition to cholestasis, making it the first study to report on the simultaneous occurrence of this triad and cholestasis.
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Affiliation(s)
- George Asafu Adjaye Frimpong
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana.,Department of Radiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - E Aboagye
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana
| | - N K Ayisi-Boateng
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - K Antwi
- County Hospital, Kumasi, Ghana
| | - K A Bawuah
- Department of Radiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - N E Coleman
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana
| | - A W Nunoo
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana
| | - D B Danso
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana
| | - M Amoah
- County Hospital, Kumasi, Ghana
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9
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Torsion of wandering spleen in an infant associated with hamartomatous vascular malformation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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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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11
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A Physician’s Nightmare: Fever of Unknown Origin. Case Rep Pediatr 2016; 2016:5437971. [PMID: 27433363 PMCID: PMC4940533 DOI: 10.1155/2016/5437971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/13/2016] [Indexed: 11/17/2022] Open
Abstract
Fever of unknown origin (FUO) remains to be a challenge despite advancement in diagnostic technologies and procedures. FUO is considered when fever presents intermittently without an explanation. It has been linked to various etiologies, which makes it difficult to diagnose. We present the case of 18-month-old female with recurrent fever, splenomegaly, abdominal pain, and constipation. The workup for her symptoms revealed wandering spleen. Wandering spleen is a result from excessive laxity or absence of splenic ligaments. The patient underwent splenectomy and was advised to continue on Senna, Miralax, and high fiber diet. Her mother reported that the fever is no longer present and there is marked improvement in her constipation and abdominal pain after splenectomy.
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12
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Katsura S, Kawamura D, Harada E, Enoki T, Hamano K. Single-incision laparoscopic splenectomy and splenic autotransplantation for an enlarged wandering spleen with torsion. European J Pediatr Surg Rep 2015; 2:23-5. [PMID: 25755963 PMCID: PMC4336060 DOI: 10.1055/s-0033-1357262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/16/2013] [Indexed: 11/29/2022] Open
Abstract
A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The transplanted splenic tissues could be identified on a spleen scintigram obtained 3 months after the surgery. Howell-Jolly bodies were not observed in blood specimens. This procedure is able to prevent an overwhelming postsplenectomy infection, and leads to satisfactory cosmetic results.
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Affiliation(s)
- Shunsaku Katsura
- Division of Pediatric Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of medicine, Ube, Yamaguchi, Japan
| | - Daichi Kawamura
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of medicine, Ube, Yamaguchi, Japan
| | - Eijiro Harada
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of medicine, Ube, Yamaguchi, Japan
| | - Tadahiko Enoki
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of medicine, Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of medicine, Ube, Yamaguchi, Japan
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13
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Sharma A, Salerno G. A torted wandering spleen: a case report. J Med Case Rep 2014; 8:133. [PMID: 24886115 PMCID: PMC4031896 DOI: 10.1186/1752-1947-8-133] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction A torted wandering spleen is a rare clinical occurrence with fewer than 500 cases reported and an incidence of less than 0.2%. It is brought about through laxity of the gastrosplenic and splenorenal ligaments; however, the precise aetiology remains unknown. It can prove to be a diagnostic challenge with high mortality if misdiagnosed. Case presentation We present the case of a 27-year-old woman of Arabic ethnicity, who complained of a short history of severe abdominal pain with the background of recurrent abdominal pain and vomiting. An abdominal computerized tomography scan revealed a torted wandering spleen. This required a splenectomy due to splenic infarction. Conclusion This report highlights the investigations and management necessary for a patient who presents with an ischaemic torted wandering spleen.
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Affiliation(s)
- Aman Sharma
- FY2 in Paediatric Surgery at John Radcliffe, Headley Way, Oxford OX3 9DU, UK.
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14
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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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15
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Heydari MB, Johari HG, Eskandari S. Wandering spleen presenting as small bowel obstruction. Am J Emerg Med 2013; 31:984-5. [PMID: 23680329 DOI: 10.1016/j.ajem.2013.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 02/10/2013] [Indexed: 12/30/2022] Open
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16
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Okazaki T, Ohata R, Miyano G, Lane GJ, Takahashi T, Yamataka A. Laparoscopic splenopexy and gastropexy for wandering spleen associated with gastric volvulus. Pediatr Surg Int 2010; 26:1053-5. [PMID: 20625747 DOI: 10.1007/s00383-010-2657-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Wandering spleen is not a common condition in childhood and has been described only rarely in association with gastric volvulus. The authors report the successful management of wandering spleen associated with gastric volvulus using laparoscopic splenopexy and gastropexy in a 4-year-old girl.
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Affiliation(s)
- Tadaharu Okazaki
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan.
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17
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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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19
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Ben Ely A, Seguier E, Lotan G, Strauss S, Gayer G. Familial wandering spleen: a first instance. J Pediatr Surg 2008; 43:E23-5. [PMID: 18485931 DOI: 10.1016/j.jpedsurg.2007.12.077] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 12/24/2007] [Accepted: 12/27/2007] [Indexed: 10/22/2022]
Abstract
We report on 2 sisters presenting with acute torsion of a wandering spleen within a 3-year interval. The diagnosis was made preoperatively by computed tomography (CT) in both cases. A high index of suspicion because of our experience with the first patient, who underwent splenectomy, enabled a correct early diagnosis in the sibling. On urgent surgery, reversible ischemic changes were found, and detorsion and splenopexy resulted in preservation of the spleen.
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Affiliation(s)
- Anna Ben Ely
- Department of Diagnostic Imaging, Sackler Faculty of Medicine, Tel Aviv University, Assaf Harofeh Medical Center, Zrifin 70300, Israel.
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20
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Falchetti D, Torri F, Dughi S, Porto C, Manciana A, Boroni G, Ekema G. Splenic cyst in a wandering spleen: laparoscopic treatment with preservation of splenic function. J Pediatr Surg 2007; 42:1457-9. [PMID: 17706517 DOI: 10.1016/j.jpedsurg.2007.03.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Wandering spleen and splenic cyst are rare benign congenital conditions that can both cause severe complications related to torsion or trauma. CASE REPORT A 14-year-old girl presented a mobile 10-cm-long abdominal mass in the left lower quadrant associated with mild abdominal pain. The diagnosis of an 8-cm-long nonparasitic cyst in a wandering spleen was confirmed by computerized tomography and negative serum indirect hemagglutination titer for hydatid disease. Laparoscopic unroofing of the cyst and splenopexy in a vycril mesh was performed. RESULTS No problems were encountered during laparoscopic surgery. Postoperative course was uneventful, and at a 1-year follow-up, the spleen is viable and maintains a normal position in the phrenorenal angle. CONCLUSIONS In the child, treatment of wandering spleen associated with a cyst should aim at the prevention of vascular accidents and at conservation of the spleen. We achieved these goals with unroofing and splenopexy through laparoscopic surgery.
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Affiliation(s)
- Diego Falchetti
- Department of Pediatric Surgery, Spedali Civili, 25100 Brescia, Italy
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21
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Upadhyaya P, St Peter SD, Holcomb GW. Laparoscopic splenopexy and cystectomy for an enlarged wandering spleen and splenic cyst. J Pediatr Surg 2007; 42:E23-7. [PMID: 17502172 DOI: 10.1016/j.jpedsurg.2007.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Wandering spleen is an uncommon condition, which can present emergently in children. Similarly, nonparasitic splenic cysts are also rarely encountered. In this report, we describe a massive wandering spleen (22 cm in longitudinal dimension) with a pseudocyst (4.6 x 2 cm) in the inferior pole in an asymptomatic 16-year-old adolescent. Only 4 similar cases have been reported in the literature; 2 of them have been in the pediatric age group. These 2 conditions were diagnosed while she was being evaluated for dysmenorrhea, and she was referred for surgical consultation. The cyst was excised laparoscopically, and the spleen was placed into an extraperitoneal pouch. To date, there are no other reports describing laparoscopic cystectomy and splenopexy in a teenager.
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Affiliation(s)
- Prashant Upadhyaya
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
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22
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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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23
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Abstract
Various congenital anomalies may affect the spleen, starting with common anomalies, such as an accessory spleen, up to rare conditions such as a wandering spleen and polysplenia. Most of these anatomic variants have no clinical significance; they need, however, to be recognized by the radiologist as such. Awareness of these variants is important for the radiologist to interpret the findings correctly and avoid mistaking them for a clinically significant abnormality. In this review we illustrate the spectrum of congenital anomalies of the spleen and stress pitfalls and possible complications resulting from these anomalies.
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Affiliation(s)
- G Gayer
- Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zrifin, Israel.
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24
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Ben Ely A, Zissin R, Copel L, Vasserman M, Hertz M, Gottlieb P, Gayer G. The wandering spleen: CT findings and possible pitfalls in diagnosis. Clin Radiol 2006; 61:954-8. [PMID: 17018308 DOI: 10.1016/j.crad.2006.06.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 06/13/2006] [Accepted: 06/14/2006] [Indexed: 11/24/2022]
Abstract
AIM To report the CT features of wandering spleen, a rare condition which can be incidentally detected as an abdominal or pelvic mass or can present with torsion, causing an acute abdomen. MATERIALS AND METHODS The CT studies of seven patients, two children and five adults, with wandering spleen were reviewed. CT was performed urgently in three patients for acute abdomen, and electively in four. RESULTS CT findings of wandering spleen included absence of the spleen in its normal position and a mass located elsewhere in the abdomen or pelvis, i.e. an ectopic spleen, enhancing homogeneously in four cases and failing partially or completely to enhance in the other three, indicating infarction. A "whirl" appearance representing the twisted splenic pedicle was seen in the three cases with torsion. Urgent splenectomy confirmed infarction secondary to torsion. CONCLUSION The possible diagnosis of wandering spleen should be kept in mind when CT shows the spleen to be absent from its usual position and a mass is found elsewhere in the abdomen or pelvis. When, in addition, a "whirl" or partial or no enhancement of this mass are seen in a case presenting with acute abdomen, torsion of a wandering spleen is a likely diagnosis.
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Affiliation(s)
- A Ben Ely
- Department of Diagnostic Imaging, Assaf Harofeh Medical Center, Zerifin, Israel.
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25
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Fukuzawa H, Urushihara N, Ogura K, Miyazaki E, Matsuoka T, Fukumoto K, Kimura S, Mitsunaga M, Hasegawa S. Laparoscopic splenopexy for wandering spleen: extraperitoneal pocket splenopexy. Pediatr Surg Int 2006; 22:931-4. [PMID: 16944182 DOI: 10.1007/s00383-006-1760-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Wandering spleen is a very rare disease. It is a very dangerous condition due to the risk of splenic ischemia from persistent pedicle torsion. Here, we describe a case of wandering spleen diagnosed by ultrasound and computed tomography scans in an 11-year-old boy who suffered from frequent urination and enuresis. A laparoscopic splenopexy was successfully performed with fixation of the spleen in an extraperitoneal pocket. Since the operation, the organ has remained in place with good perfusion. The details of the procedure are described.
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Affiliation(s)
- Hiroaki Fukuzawa
- Department of Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
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26
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Abstract
Wandering spleen is a very uncommon condition. Because of the risk of pedicle torsion and splenic ischemia, severe consequences may occur if not diagnosed and treated in time. Unfortunately, splenectomy is sometimes necessary (ie, when splenic infarction occurs). Once the diagnosis of wandering spleen is made, splenopexy is the treatment of choice. There are numerous techniques designed for splenopexy, either by open surgery or by minimally invasive approaches. We describe here a laparoscopic procedure that allows an excellent fixation of the spleen using the patient's own tissues. After a 2-year follow-up, the organ remains in place with good perfusion.
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Affiliation(s)
- Marcelo Martínez-Ferro
- Division of Pediatric Surgery, National Pediatric Hospital "Juan P. Garrahan," B1636 DIK Buenos Aires, Argentina.
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27
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Schaarschmidt K, Lempe M, Kolberg-Schwerdt A, Schlesinger F, Hayek I, Jaeschke U. The technique of laparoscopic retroperitoneal splenopexy for symptomatic wandering spleen in childhood. J Pediatr Surg 2005; 40:575-7. [PMID: 15793739 DOI: 10.1016/j.jpedsurg.2004.11.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Wandering spleen is an uncommon diagnosis, difficult to prove by standard investigations. The authors report a new method for laparoscopic splenopexy in children using a balloon-dilated retroperitoneal pouch. METHODS From 3 accesses, the spleen is mobilized and displaced into a retroperitoneal pouch dilated to the double splenic volume. The pouch is dilated by a self-made balloon via a further intercostal access and narrowed by sutures incorporating the cranial and caudal edge of the gastrosplenic ligament. RESULTS The peritoneal pouch contracts around the retroperitoneal spleen resulting in a firm fixation of the organ. This technique was successful in a 9-year-old girl with a 5-year history of severe recurrent abdominal pain. CONCLUSIONS Laparoscopic retroperitoneal pouch splenopexy is a safe and effective procedure for symptomatic wandering spleen precluding the use of foreign materials in this age group.
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Affiliation(s)
- Klaus Schaarschmidt
- Helios-Center for Pediatric Surgery, Klinikum Buch, D-13125 Berlin, Germany.
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28
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Affiliation(s)
- J A A Awe
- Surgical Outpatient Department, Northern Area Armed Forces Hospital, King Khalid Military City, Hafr Al-Batin, Saudi Arabia.
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29
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Breisch EA, Krous HF. Autoinfarcted wandering spleen and fatal pneumococcal sepsis in an infant. Pediatr Dev Pathol 2005; 8:132-5. [PMID: 15717114 DOI: 10.1007/s10024-004-7082-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 10/25/2004] [Indexed: 11/29/2022]
Abstract
A wandering or ectopic spleen, a rare congenital condition caused by improper fixation of the ligamentous attachments, was identified during a postmortem examination of a 10-month-old female who had died of Streptococcus pneumoniae sepsis. The wandering spleen was autoinfarcted and adherent to the left hepatic lobe, with resultant functional hyposplenism.
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Affiliation(s)
- Eric A Breisch
- Department of Pathology, Children's Hospital and Health Center, 3020 Children's Way, M5007, San Diego, CA 92123, USA.
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30
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Corcione F, Caiazzo P, Cuccurullo D, Miranda L, Settembre A, Pirozzi F, Bruzzese G. Laparoscopic splenectomy for the treatment of wandering spleen. Surg Endosc 2004; 18:554-6. [PMID: 15115016 DOI: 10.1007/s00464-003-4254-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Wandering spleen is a very rare pathologic condition that initially presents with unremarkable clinical symptoms, then dramatically manifests severe complications. A case of wandering spleen treated with laparoscopic splenectomy is described and compared with other similar reports in the literature. Laparoscopic exploration of the abdominal cavity allowed the diagnosis to be confirmed and splenectomy to be performed. An enlarged spleen led to the choice of total splenectomy to avoid both future complications and future organ torsion resulting from the long and twisted vascular pedicle. The laparoscopic approach led to a rapid recovery, a 3-day postoperative course, and satisfactory cosmetic results.
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Affiliation(s)
- F Corcione
- A.O. Monaldi, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione, U.O.C. di Chirurgia Generale, Naples, Italy
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