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Khan H, Fatima K, Aman M, Khan F, Khan P, Safi MI. Wandering spleen with acute torsion mimicking an adnexal mass. Radiol Case Rep 2023; 18:4094-4098. [PMID: 37727144 PMCID: PMC10505588 DOI: 10.1016/j.radcr.2023.08.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/12/2023] [Indexed: 09/21/2023] Open
Abstract
Wandering spleen manifests when the splenic ligaments are underdeveloped, or become lax, thereby allowing the spleen to relocate from its anatomical site to more distant areas. During such movements, torsion of the long splenic peduncle is common, which can lead to symptoms of acute abdomen and further complications such as infarction. It is typically seen in children and young females. Our report presents a case of a 22-year-old female presenting to the ER with complaints of severe pain in the abdominal region. On ultrasound, there was suspicion of an adnexal mass, which was later confirmed to be a misplaced spleen in the lower abdomen, with torsion, fat stranding, and splenic vein thrombosis, as revealed by enhanced CT abdomen and pelvic MRI. It was followed by an emergency splenectomy. As wandering spleen presents nonspecifically and is a rare condition, it is important to consider wandering spleen when patients present similarly to this case, to prevent misdiagnosis and to deliver surgical treatment quickly to preserve the spleen.
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Affiliation(s)
- Hana Khan
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Kulsoom Fatima
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Aman
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Faheemullah Khan
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Poonum Khan
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Ismail Safi
- Department of Radiology, Nishtar National Kidney Hospital, Jalalabad, Afghanistan
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2
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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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3
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Anne Ng MR, Mccullers M, Gamenthaler A. Wandering Spleen with 720-degree Torsion Treated with Splenectomy and Distal Pancreatectomy. Am Surg 2019. [DOI: 10.1177/000313481908500825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Wandering spleen is a rare condition, typically not only due to embryological defects of the splenic ligaments, but also secondary to trauma and splenomegaly. The most common presentation is acute abdomen with a mobile abdominal mass or recurrent abdominal pain. However, the spleen may be temporary in its normal position, and patients could be asymptomatic. A familiarity, if present, strengthens the diagnostic suspect.Abdominal ultrasonography and computed tomography are the examination of choice, and the management is surgical.
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5
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Piccoli M, De Luca GM, Pasculli A, Angelini M, Guicciardi L, Mullineris B, Marchi D, Melotti G. Laparoscopic transperitoneal left adrenalectomy and wandering spleen risk. JSLS 2016; 18:JSLS-D-13-00278. [PMID: 25392630 PMCID: PMC4154420 DOI: 10.4293/jsls.2014.00278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Laparoscopic transperitoneal left adrenalectomy (LTLA) has become the standard treatment for adrenal masses <6 cm. LTLA involves the dissection of splenic suspensory ligaments, which replicates their congenital absence or weakening, present in cases of wandering spleen (WS). WS is a rare condition in which the spleen migrates from the left upper quadrant to a more caudal location in the abdomen. A unique case of WS after LTLA was described by Corcione et al. In this prospective study, we investigated the possibility of WS as a consequence of LTLA. Methods: Twenty-four patients, 8 men and 16 women, who underwent LTLA with the dissection of splenoparietal and splenorenal ligaments were selected. Results: Clinical and ultrasonographic follow-up showed no evidence of postoperative WS. Conclusions: In the literature, WS is not commonly reported as a postoperative complication of LTLA. In effect, especially in the case of small adrenal masses, the spleen's repositioning in its seat is autonomous. However, the alarming possibility of WS should not be ignored, especially in the case of extensive dissection of the left colic flexure. It would be useful for other authors to signal this complication, so that different approaches and consequent results may be compared.
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Affiliation(s)
- Micaela Piccoli
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
| | - Giuseppe Massimiliano De Luca
- Department of Biomedical Sciences and Human Oncology, Section of General and Oncologic Surgery, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - Alessandro Pasculli
- Department of Biomedical Sciences and Human Oncology, Section of General and Oncologic Surgery, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | - Marta Angelini
- Department of Radiology, Vignola Hospital, Vignola, Italy
| | - Lorenzo Guicciardi
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
| | - Barbara Mullineris
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
| | - Domenico Marchi
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
| | - Gianluigi Melotti
- Department of General Surgery, New S. Agostino Estense Hospital N.O.C.S.A.E. Baggiovara, Modena, Italy
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Abstract
Wandering spleen or splenoptosis is an uncommon entity and often an asymptomatic finding of acute abdomen in the emergency department. A high index of suspicion for splenic torsion is required, particularly in patients with known splenomegaly, as this condition could potentially lead to splenic infarction. Recognition of this condition can help avoid potential confusion with acute abdomen of other aetiologies. Herein, we present a unique case of wandering spleen with chronic torsion, which, to the best of our knowledge, has never been described in an elderly patient with haemoglobin H thalassaemia. We also review the literature for the aetiology and pathogenesis of wandering spleen, and discuss the relevant diagnostic modalities and treatment options.
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Affiliation(s)
- Chi Long Ho
- Department of Diagnostic Radiology, Singapore General Hospital, 4 Outram Road, Singapore 169608.
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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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8
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Polat A, Ozgurler F, Balcı YI, Kocyigit A, Tan M. Hereditary spherocytosis and wandering spleen. Pediatr Hematol Oncol 2014; 31:101-3. [PMID: 24088174 DOI: 10.3109/08880018.2013.831150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Aziz Polat
- Division of Pediatric Hematology, Pamukkale University Faculty of Medicine , Denizli , Turkey
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9
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Leci-Tahiri L, Tahiri A, Bajrami R, Maxhuni M. Acute abdomen due to torsion of the wandering spleen in a patient with Marfan Syndrome. World J Emerg Surg 2013; 8:30. [PMID: 23915457 PMCID: PMC3751152 DOI: 10.1186/1749-7922-8-30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/23/2013] [Indexed: 11/10/2022] Open
Abstract
Wandering spleen is a very rare defect characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the upper left abdomen. Patient symptomatology is variable and ranges from mere feeling of an abdominal lump to sudden abdominal pain due to infarction. Patients may have subacute to chronic abdominal or gastrointestinal complaints. Because of nonspecific symptoms, clinical diagnosis can be difficult; hence, imaging plays an important role. A major complication is splenic torsion, which is the cause of acute abdomen. We present a case of acute abdominal pain due to torsion of wandering spleen in a patient with Marfan Syndrome, valvular heart disease, and vertebral anomalies. Preoperative diagnosis was made on the basis of ultrasonography and computed tomography, which was later confirmed on surgery, and treated successfully.
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Affiliation(s)
- Laura Leci-Tahiri
- Clinic of Surgery, University Clinical Center of Kosova, Prishtina, Kosova.
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10
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Penn A, Wang W, Wang ZJ, Yee J, Webb EM, Yeh BM. Demographics and frequency of the intermittently upturned omentum at CT. Eur J Radiol 2013; 82:e637-40. [PMID: 23906439 DOI: 10.1016/j.ejrad.2013.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 05/23/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the demographics and frequency of the intermittently upturned omentum at CT. METHODS We retrospectively reviewed abdominal CT scans of 336 consecutive patients (189 men and 147 women) who were imaged between June 1 and June 17, 2010 and who had prior comparison scans. Readers recorded the presence or absence of an intermittently upturned omentum, defined as a thick rind of fat interposed between the liver and the anterior abdominal wall seen on one but not the other scan. At chart review, we recorded patient demographics and other clinical characteristics (prior surgical history, presence of cirrhosis). RESULTS An intermittently upturned omentum was found in 10 of 336 (3.0%) patients. An intermittently upturned omentum was seen more commonly in men than in women (9 of 189 men, or 4.8% versus 1 of 147 women, or 0.7%, p=0.047) and in cirrhotics (4 of 37 cirrhotics, or 10.8% versus 6 of 299 non-cirrhotics, or 2.0%, p=0.023). In a sub-analysis of patients without prior abdominal surgery, this finding was again seen more commonly in men than women (7 of 163 men, or 4.3% versus 0 of 134 women, or 0%, p=0.018) and in cirrhotics (3 of 33 cirrhotics, or 9.1% versus 4 of 264 non-cirrhotics, or 1.5%, p=0.032). CONCLUSIONS An intermittently upturned omentum is not uncommon and is more frequently seen in men and in patients with cirrhosis who may have a larger anterior hepatic space.
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Affiliation(s)
- Alex Penn
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Department of Radiology (AP, WW, ZJW, JY, EMW, BMY), University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, United States
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11
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Bekheit M, Katri KM, Ezzat T. Wandering hemi-spleen: Laparoscopic management of wandering spleen in a case of polysplenia. Int J Surg Case Rep 2012; 3:151-4. [PMID: 22382032 DOI: 10.1016/j.ijscr.2011.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/10/2011] [Accepted: 10/11/2011] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Several congenital anomalies of the spleen have been reported. The polysplenia is a rare anomaly in which the normal spleen is replaced with two or more smaller spleens. The wandering spleen is another anomaly resulting from the laxity of the splenic ligaments. The concomitance of both anomalies is very rare. PRESENTATION OF A CASE A 22-year old female patient presented with intermittent left hypochondrial pain for more than a year. After a thorough examination of the patient, she only had bilateral accessory nipples. Routine laboratory investigations were all normal. An abdominal ultrasound U/S scan was unremarkable except for a ptotic spleen. with a large splenule 5cm×3cm located near the fundus of the stomach. These findings were confirmed by a CT scan. A decision for a surgical intervention was then made, and the laparoscopic approach was chosen which revealed the condition. Laparoscopic removal of the wandering part was executed. The patient discharged on the first post-operative day. DISCUSSION The decision making in cases of wandering spleen is not always the same. The association of a wandering spleen with polysplenia is an asset to the surgical decision, along with the age of the patient. CONCLUSION The laparoscopic approach is an important tool in the diagnosis and management of wandering spleen. The diagnosis of polysplenic anomaly could provide a guidance for the surgical strategy in patients with wandering spleen.
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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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13
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François-Fiquet C, Belouadah M, Chauvet P, Lefebvre F, Lefort G, Poli-Merol ML. Laparoscopic gastropexy for the treatment of gastric volvulus associated with wandering spleen. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S137-9. [PMID: 19281417 DOI: 10.1089/lap.2008.0091.supp] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 2.5-year-old boy was referred to the emergency room for a sudden onset of diffuse and increasing abdominal pain with lethargy, abdominal distension, and vomiting, all in the past 24 hours. A plain abdominal X-ray showed gastric distension. Two liters of gastric contents were evacuated by suction. The abdominal sonogram showed an unusual position of the spleen in the left-lower quadrant, with no splenic ischemia. The diagnosis of gastric volvulus associated with a wandering spleen was then evoked. Laparoscopic exploration revealed a nonischemic spleen, absence of normal supporting ligaments for the spleen, and gastric distension with flaccid gastric walls. The spleen was then easily moved in the left-under quadrant. A parietal peritoneal posterolateral incision was made, opposite the large gastric curve, up to the diaphragm (7 cm). This delimitated a sharp demarcation zone between the two edges of the incised peritoneum. The stomach was fixed to the peritoneal incision, covering and anchoring the spleen in a good position. Recovery was uneventful, and an abdominal sonogram performed 4 years after the surgery shows a viable spleen in its correct location. The rarity of gastric volvulus associated with a wandering spleen and its fast clinical improvement with medical treatment often delays the diagnosis and the surgical treatment. Laparoscopy in this case has a dual relevance: diagnosis and therapeutic management (splenectomy or gastropexy). Laparoscopic gastropexy for the treatment of gastric volvulus associated with a wandering spleen is an easy procedure and combines the advantages of all the surgical techniques previously described.
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14
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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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15
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Singla V, Galwa RP, Khandelwal N, Poornachandra KS, Dutta U, Kochhar R. Wandering spleen presenting as bleeding gastric varices. Am J Emerg Med 2008; 26:637.e1-4. [PMID: 18534317 DOI: 10.1016/j.ajem.2007.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Accepted: 10/24/2007] [Indexed: 12/18/2022] Open
Abstract
Ectopic spleen (splenoptosis) is an extremely rare condition in which the spleen is present in a nonanatomical position. Patients' symptomatology is variable and ranges from mere feeling of an abdominal lump to sudden abdominal pain due to infarction. Patient may have subacute to chronic abdominal or gastrointestinal complaints. Because of nonspecific symptoms, clinical diagnosis can be difficult; hence, imaging plays an important role. Presentation as a case of portal hypertension is extremely rare. We report a case of splenic torsion in a middle-aged woman who presented with hemetemesis from gastric varices secondary to chronic volvulus of an ectopic spleen. Preoperative diagnosis was made on the basis of ultrasonography, endoscopy, and computed tomography, which was later proved on surgery and treated successfully.
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Affiliation(s)
- V Singla
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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16
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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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17
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Liu HTM, Lau KK. Wandering spleen: an unusual association with gastric volvulus. AJR Am J Roentgenol 2007; 188:W328-30. [PMID: 17376999 DOI: 10.2214/ajr.05.0672] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Huai-Tzu Michael Liu
- Department of Radiology, Monash Medical Center, Rm. 116, 246 Clayton Rd., Clayton South, Victoria 3168, Australia.
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18
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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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19
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Park KS, Shin MS, Kim SY, Sul JY, Lee KS. Acute Torsion of a Wandering Spleen Managed by Splenopexy. THE KOREAN JOURNAL OF HEMATOLOGY 2005. [DOI: 10.5045/kjh.2005.40.4.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kyoung Soo Park
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Myung Seok Shin
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Young Kim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji Young Sul
- Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Keon Su Lee
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
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