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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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Su JZ, Fan SF, Song X, Cao LJ, Su DY. Wandering small intestinal stromal tumor: A case report. World J Clin Cases 2022; 10:10622-10628. [PMID: 36312500 PMCID: PMC9602228 DOI: 10.12998/wjcc.v10.i29.10622] [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: 05/11/2022] [Revised: 08/16/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The occurrence of gastrointestinal stromal tumors (GISTs) in the small intestine is rare, and a case of wandering small intestinal stromal tumor has been rarely reported to date. Dissemination of this case can help inform future diagnosis and effective treatment.
CASE SUMMARY A 68-year-old patient presented to us with tarry stools. Computed tomography showed a mobile tumor moving widely within the abdominal cavity. As the laboratory data showed a low range of red blood cells and an immediate surgery was not indicated, we performed digital subtraction angiography and embolization to achieve hemostasis. Surgical resection was performed after the patient’s condition improved. The tumor was successfully removed laparoscopically. Histological examination revealed submucosal GIST with infarction, which was of intermediate-risk, with mitotic count < 1 per 10 high-power field. Immunohistochemical studies revealed the following: CD117+, Dog1+, CD34+, SMA+, S100-, CK-, Des-, SOX-11-, STAT6-, Ki67 Hotspots 10%+. The patient was ultimately diagnosed with wandering small intestinal stromal tumor.
CONCLUSION When a highly vascularized tumor is clinically encountered in the small intestine, the possibility of stromal tumors should be considered. However, when the tumor cannot be visualized at its original location, the possibility of tumor migration is considered.
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Affiliation(s)
- Jin-Zhan Su
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Shu-Feng Fan
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Xia Song
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Lu-Jun Cao
- Department of Radiology, The Hospital of the Zhejiang University, Hangzhou 310058, Zhejiang Province, China
| | - Dong-Ying Su
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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Wang Z, Peng C, Wu D, Wang K, Chen Y. Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction. BMC Pediatr 2022; 22:440. [PMID: 35864485 PMCID: PMC9306085 DOI: 10.1186/s12887-022-03484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction. Methods From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized. Results There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4–170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient. Conclusions Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03484-y.
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Affiliation(s)
- Zengmeng Wang
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Chunhui Peng
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Dongyang Wu
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Kai Wang
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Yajun Chen
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China.
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Kachare M, Jaisinghani P. Torsion of a Wandering Spleen Involving the Pancreatic Tail and Splenic Flexure and Isolated Left-Sided Portal Hypertension due to Chronic Splenic Vein Thrombosis. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1749672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Wandering spleen is a rare entity, wherein the spleen is attached only by an elongated vascular pedicle, predisposing it to complications like hilar torsion, infarction, rupture, etc. Pancreatic volvulus is another very rare anomaly, with isolated case reports described in association with wandering spleen. The presentation varies from asymptomatic lump (stimulating a mass) to acute abdomen (due to torsion). We present a case of 26-year-old female patient who complained of pain in abdomen, and was radiologically diagnosed and surgically confirmed to have a torsion of wandering spleen with involvement of pancreatic tail and splenic flexure. Few cases with associated finding of gastric volvulus and sigmoid volvulus have been described previously. Involvement of descending colon in a 9-year-old child has been reported. However, to the authors' knowledge, this is the first case report describing the combination of wandering spleen with splenic flexure and pancreatic tail involvement in an adult.
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Affiliation(s)
- Manohar Kachare
- Department of Radiodiagnosis, Government Medical College Miraj, Miraj, Maharashtra, India
| | - Pooja Jaisinghani
- Department of Radiodiagnosis, Government Medical College Miraj, Miraj, Maharashtra, India
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Patients with gastric volvulus recurrence have high incidence of wandering spleen requiring laparoscopic gastropexy and splenopexy. Pediatr Surg Int 2022; 38:875-881. [PMID: 35391540 DOI: 10.1007/s00383-022-05125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Though gastric volvulus in neonates and infants resolves by conservative therapy and aging, some cases require surgical intervention. This study aimed to review the cases of gastric volvulus requiring surgical intervention and evaluate their characteristics. METHODS We retrospectively reviewed gastric volvulus cases requiring surgical intervention. Surgical indication was persistent acute gastric volvulus and repeated hospitalization for gastric volvulus. We evaluated the characteristics of those cases requiring surgical intervention and the surgical results of laparoscopic gastropexy. RESULTS The median age of patients included was 4 years (range: 1-6 years). All eight cases of gastric volvulus requiring sugery had congenital spleen diseases. Six of the eight cases suffered from a wandering spleen, while two cases presented with situs inversus with asplenia. Both splenopexy (preperitoneal distension balloon [PDB] or blunt separaion methods) and gastropexy were performed in cases with wandering spleen. No postoperative complications were reported in any of the eight cases, except the recurrence of gastric volvulus due to suture shedding in one case. CONCLUSION Laparoscopic gastropexy for gastric volvulus and splenopexy for cases concomitant with wandering spleen were found to be effective surgical approaches. Both PDB and blunt separation methods for making extraperitoneal pockets for the spleen were employed successfully.
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Vlastarakos P, Rouvali A, Giourga M, Gerede A, Domali E. Wandering Spleen: A Rare Case of an Adnexal Lesion. Cureus 2021; 13:e18231. [PMID: 34703712 PMCID: PMC8542105 DOI: 10.7759/cureus.18231] [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] [Accepted: 09/23/2021] [Indexed: 12/05/2022] Open
Abstract
The wandering spleen (WS) is a rare condition in which the spleen is not found in its usual location in the left hypochondrium but is positioned in the lower abdomen or the pelvis. This is a case of a 21-year-old woman who presented with chronic, intermittent, and subtle pain in the left lower quadrant of her abdomen. After clinical examination and ultrasound evaluation, an adnexal lesion was detected in the left lumbar area, and no splenic tissue was found in the left hypochondrium. The wandering spleen should be included in the differential diagnosis when encountering a patient with non-typical or acute abdominal pain. Accurate diagnostic evaluation can be performed with low-cost imaging modalities such as Doppler ultrasound.
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Affiliation(s)
- Panagiotis Vlastarakos
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra Hospital', National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Angeliki Rouvali
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra Hospital', National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Maria Giourga
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra Hospital', National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Angeliki Gerede
- Department of Obstetrics and Gynecology, Democritus University of Thrace Alexandroupolis, Greece, Alexandroupolis, GRC
| | - Ekaterini Domali
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens 'Alexandra Hospital', National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Jha AK, Bhagwat S, Dayal VM, Suchismita A. Torsion of spleen and portal hypertension: Pathophysiology and clinical implications. World J Hepatol 2021; 13:774-780. [PMID: 34367498 PMCID: PMC8326160 DOI: 10.4254/wjh.v13.i7.774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
The displacement of spleen from its normal location to other places is known as wandering spleen (WS) and is a rare disease. The repeated torsion of WS is due to the presence of long pedicle and absence/laxity of anchoring ligaments. A WS is an extremely rare cause of left-sided portal hypertension (PHT) and severe gastric variceal bleeding. Left-sided PHT usually occurs as a result of splenic vein occlusion caused by splenic torsion, extrinsic compression of the splenic pedicle by enlarged spleen, and splenic vein thrombosis. There is a paucity of data on WS-related PHT, and these data are mostly in the form of case reports. In this review, we have analyzed the data of 20 reported cases of WS-related PHT. The mechanisms of pathogenesis, clinico-demographic profile, and clinical implications are described in this article. The majority of patients were diagnosed in the second to third decade of life (mean age: 26 years), with a strong female preponderance (M:F = 1:9). Eleven of the 20 WS patients with left-sided PHT presented with abdominal pain and mass. In 6 of the 11 patients, varices were detected incidentally on preoperative imaging studies or discovered intraoperatively. Therefore, pre-operative search for varices is required in patients with splenic torsion.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Sameer Bhagwat
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Vishwa Mohan Dayal
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Arya Suchismita
- Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, Delhi 110070, India
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