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Sun C, Li SL. Successful treatment of floating splenic volvulus: Two case reports and a literature review. World J Clin Cases 2021; 9:8812-8819. [PMID: 34734060 PMCID: PMC8546827 DOI: 10.12998/wjcc.v9.i29.8812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The floating spleen refers to the spleen moving away from the normal anatomical position to other parts of the abdominal cavity.
CASE SUMMARY In this report, we describe two cases of torsion of floating spleen, which were successfully treated by laparoscopic partial splenectomy and retroperitoneal fixation of the residual spleen. The clinical characteristics of previously reported cases are also discussed.
CONCLUSION In conclusion, laparoscopic partial resection of splenic volvulus infarction and extraperitoneal fixation of residual spleen are safe and reliable.
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Affiliation(s)
- Chi Sun
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Suo-Lin Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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2
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Guo H, Ba X, Gong P, Wang G, Ma H, Wang L, Wang Q. Abdominopelvic ectopic spleen with a comprehensive imaging examination: a case report. J Int Med Res 2021; 49:3000605211000511. [PMID: 33730926 PMCID: PMC8166395 DOI: 10.1177/03000605211000511] [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] [Indexed: 11/15/2022] Open
Abstract
Ectopic spleen is a rare clinical malformation in which the spleen is relocated from its normal anatomical position to other parts of the abdomen. We report a rare case of abdominopelvic ectopic spleen caused by splenic ligament deficiency. A patient experienced intermittent pain in the left upper abdomen that was progressively aggravated. This was confirmed by comprehensive imaging examinations and postoperative pathology. We also performed a review of the literature on the current state of the field. Our data may help to improve the diagnosis and treatment of ectopic spleen.
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Affiliation(s)
- Hao Guo
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China.,Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Xinru Ba
- Department of Radiology, Yaitai Shan Hospital, Yantai, Shandong Province, China
| | - Peiyou Gong
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Guangzhi Wang
- Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Weifang, Shandong Province, China
| | - Heng Ma
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Liying Wang
- Department of Radiology, Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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3
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Mohseni M, Kruse BT, Graham C. Splenic torsion: a rare cause of abdominal pain. BMJ Case Rep 2018; 2018:bcr-2018-224952. [PMID: 30021736 DOI: 10.1136/bcr-2018-224952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Splenic torsion is an exceedingly rare but clinically important disease process that should be recognised promptly by the treating physician. In this condition, there is twisting of the spleen along its vascular pedicle, subsequently leading to abdominal pain in the setting of organ ischaemia. Vascular thrombosis and splenic infarction may ensue. Torsion has been described in cases of a known wandering spleen. Abnormal development of the splenic suspensory ligaments may predispose a patient to a wandering spleen. Treatment of splenic torsion is typically surgical, with goals of preservation of the spleen if possible.We present a case of a young woman who presented with left-sided chest and abdominal pain and was found to have splenic torsion with complete splenic infarction. Surgical intervention was required, and splenectomy was performed. In this case presentation, we outline the multidisciplinary approach needed to care for the patient with this rare condition.
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Affiliation(s)
- Michael Mohseni
- Emergency Medicine, Mayo Clinic's Campus in Florida, Jacksonville, Florida, USA
| | - Brian T Kruse
- Emergency Medicine, Mayo Clinic's Campus in Florida, Jacksonville, Florida, USA
| | - Charley Graham
- Emergency Medicine, Mayo Clinic's Campus in Florida, Jacksonville, Florida, USA
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4
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Rizzuto A, Di Saverio S. Laparoscopic splenectomy for a simultaneous wandering spleen along with an ectopic accessory spleen. Case report and review of the literature. Int J Surg Case Rep 2018; 43:36-40. [PMID: 29482086 PMCID: PMC5907687 DOI: 10.1016/j.ijscr.2018.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/08/2018] [Accepted: 01/21/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Wandering spleen and accessory spleen are uncommon entity occurring during embryonic development. Wandering spleen results in an excessive mobility and migration of the spleen from its normal position in the left hypochondrium while accessory spleen is characterized by ectopic splenic masses or tissue disjointed from the main body of spleen. Due to the nonspecific and multiple symptoms the clinical diagnosis of both conditions is uncertain even with imaging techniques, such as CT and MRI. The coexistence of both diseases (wandering spleen ad accessory spleen) is uncommon. CASE REPORT A 17-year old European female with a history of minor beta thalassemia and recurrent attacks of abdominal pain. Pre- operative management consisted of routine laboratory tests, ultrasound, CT scan. An ectopic spleen along with an accessory spleen were diagnosed. After a multidisciplinary board a laparoscopic splenectomy was performed. Post-operative recovery was uneventful, and the patient was discharged on the 6th post-operative day with the indication to continue the therapy with low molecular weight heparin (LMWH) for 30 days CONCLUSIONS: This case represents a simultaneous condition of wandering splenomegaly along with an ectopic wandering spleen. The coexistence of these two rare conditions is peculiar such as the age of the patient, as literature reports such diseases to affect children or more commonly people in the range of 20-40 years of age. Laparoscopic treatment for this particular condition is also unusual.
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Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
| | - Salomone Di Saverio
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
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5
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Morgan S, Glenn I, Soldes O. Laparoscopic splenopexy for wandering spleen, a video demonstration of technique by encircling the spleen with polyglactin 910 woven mesh. Surg Endosc 2017; 31:5427-5428. [DOI: 10.1007/s00464-017-5630-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/01/2017] [Indexed: 11/28/2022]
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6
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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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7
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Abstract
Wandering spleen, also referred to as ‘ptotic spleen’, is a rare clinical condition characterized by splenic migration form its normal left hypochondrial position to any other abdominal or pelvic position. Among the multifactorial etiologies proposed, laxity of the spleen’s primary supporting ligaments is the most agreed-upon hypothesis. We present one rare case of wandering spleen in an 11-year-old girl who presented with recurrent abdominal pain with no localizing features. Her abdominal examination revealed an intra-abdominal left iliac fossa lump with restricted mobility, which was confirmed as a wandering spleen by abdominal sonography and contrast-enhanced computed tomography. Intraoperatively, an infarcted spleen was encountered with tortuous, elongated, torsional splenic pedicle and a single dense adhesive band with descending colon. Splenectomy was offered to the patient. Post-operatively, the patient is healthy and symptom free at one-year follow-up. The rare clinical diagnosis of this condition, particularly in the paediatric age-group, makes it an enigma for the surgical world.
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Affiliation(s)
| | - Rohit Mehra
- Department of Surgery, Armed Forces Medical College, Pune, Maharashtra, India
| | - Sushila Chauhan
- Department of Surgery, Command Hospital, Pune, Maharashtra, India and
| | - Rahul Pandey
- Department of Surgery, Command Hospital, Pune, Maharashtra, India and
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8
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Yoldaş Ö, Karabuğa T, Özsan İ, Şahin E, Limon Ö, Aydın Ü. Laparoscopic splenectomy for a wandering spleen causing chronic pelvic pain. ULUSAL CERRAHI DERGISI 2015; 32:292-294. [PMID: 28149130 DOI: 10.5152/ucd.2015.2850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/16/2014] [Indexed: 11/22/2022]
Abstract
Wandering spleen is a rare condition with a reported incidence of less than 0.5% in which the spleen migrates from its normal anatomical location to any other position in the abdomen. Women constitute 80% of cases and one third of the overall patients are children. It has different clinical presentations such as asymptomatic, painless mass in the abdomen, intermittent abdominal pain and acute abdomen due to torsion of the vascular pedicle. Here we present a case of wandering spleen causing chronic pelvic pain. Laparoscopic splenopexy was the treatment choice but it could not be performed due to huge size of the wandering spleen.
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Affiliation(s)
- Ömer Yoldaş
- Department of General Surgery, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - Türker Karabuğa
- Department of General Surgery, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - İsmail Özsan
- Department of General Surgery, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - Erkan Şahin
- Department of Radiology, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - Önder Limon
- Department of Emergency Medicine, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - Ünal Aydın
- Department of General Surgery, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
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9
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Rellum R, Risseeuw G, Blaauw ID, Lequin M. Splenorenal collaterals as hallmark for a twisted wandering spleen in a 14-year-old girl with abdominal pain: a case report. European J Pediatr Surg Rep 2014; 2:26-8. [PMID: 25755964 PMCID: PMC4336078 DOI: 10.1055/s-0034-1370776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/27/2013] [Indexed: 11/15/2022] Open
Abstract
Wandering spleen is a rare cause of acute or chronic recurrent abdominal pain with a risk of splenic torsion and infarction. We describe a case of a 14-year-old girl with chronic recurrent abdominal pain with a palpable spleen in normal position on the initial physical examination. Laboratory findings were normal. A normal blood flow was seen on the initial (color Doppler) sonography. Magnetic resonance imaging showed an enlarged spleen in the pelvic region with torsion of hilar pedicle and splenorenal collaterals. Semielective, a laparoscopic splenopexy was performed without complications. A twisted wandering spleen should be included in the differential diagnosis of recurrent abdominal pain despite possible normal positioning of the spleen. The presence of splenorenal collaterals on imaging techniques can be used as a diagnostic hallmark.
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Affiliation(s)
- Rashidi Rellum
- Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Gerard Risseeuw
- Department of Radiology, Ruwaard van Putten Hospital, Spijkenisse, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud Medical Centre, Nijmegen, The Netherlands
| | - Maarten Lequin
- Department of Radiology, Sophia Childrens Hospital, Rotterdam, The Netherlands
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10
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Bouzaidi K, Daghfous A, Ben Ali M, Karma S, Rezgui Marhoul L. [Infarction of a wandering spleen - a case report]. Presse Med 2013; 43:225-8. [PMID: 24184280 DOI: 10.1016/j.lpm.2013.04.022] [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] [Received: 02/19/2013] [Revised: 04/11/2013] [Accepted: 04/30/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Khaled Bouzaidi
- Hôpital MT Maâmouri, service d'imagerie médicale, 8000 Nabeul, Tunisie
| | - Alifa Daghfous
- Centre des grands brulés, service d'imagerie médicale, 2013 Ben Arous, Tunisie.
| | - Mechaal Ben Ali
- Hôpital MT Maâmouri, service d'anesthésie réanimation, 8000 Nabeul, Tunisie
| | - Sahbi Karma
- Hôpital MT Maâmouri, service d'imagerie médicale, 8000 Nabeul, Tunisie
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11
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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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12
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Pérez-Legaz J, Moya Forcén P, Oller I, Arroyo A, Calpena R. Bazo ectópico. ¿Cirugía urgente o programada? Cir Esp 2013; 91:344-5. [DOI: 10.1016/j.ciresp.2011.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 10/05/2011] [Indexed: 11/16/2022]
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13
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Prune belly syndrome, splenic torsion, and malrotation: a case report. J Pediatr Surg 2013; 48:e41-3. [PMID: 23414901 DOI: 10.1016/j.jpedsurg.2012.11.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 11/24/2022]
Abstract
An 18 year old male with a history of prune belly syndrome (PBS) presented with acute abdominal pain and palpable left upper quadrant mass. Computed tomography (CT) of the abdomen revealed a medialized spleen with a "whirl sign" in the splenic vessels, consistent with splenic torsion. Coincidentally, the small bowel was also noted to be on the right side of the abdomen, while the colon was located on the left, indicative of malrotation. Emergent diagnostic laparoscopy confirmed splenic torsion and intestinal malrotation. Successful laparoscopic reduction of the splenic torsion was achieved, however, conversion to an open procedure by a vertical midline incision was necessary owing to the patient's unique anatomy. Open splenopexy with a mesh sling and Ladd's procedure were subsequently performed. Malrotation and wandering spleen are known, rare associated anomalies in PBS; however, both have not been reported concurrently in a patient with PBS in the literature. In patients with PBS, acute abdominal pain, and an abdominal mass, high clinical suspicion for gastrointestinal malformations and prompt attention can result in spleen preservation and appropriate malrotation management. We present a case of a teenager who presented with a history of PBS, acute abdominal pain, and a palpable abdominal mass. The patient was found to have splenic torsion and intestinal malrotation. The clinical findings, diagnostic imaging, and surgical treatment options of splenic torsion are reviewed.
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Fabiano P, Rosado R, Maturana V, Ramírez D. [Laparoscopic splenectomy for torsion of a wandering spleen]. Cir Esp 2012; 90:477-8. [PMID: 22771291 DOI: 10.1016/j.ciresp.2012.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 03/20/2012] [Accepted: 04/08/2012] [Indexed: 11/30/2022]
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Fonseca AZ, Ribeiro M, Contrucci O. Torsion of a wandering spleen treated with partial splenectomy and splenopexy. J Emerg Med 2012; 44:e33-6. [PMID: 22381612 DOI: 10.1016/j.jemermed.2011.06.146] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 05/06/2011] [Accepted: 06/11/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Wandering spleen is a rare and unusual entity, characterized by excessive mobility and displacement of the organ from its normal position. This happens due to congenital or acquired anomalies leading to the lack of the spleen's suspensory ligaments. Clinical presentation is variable; acute abdominal pain may occur when persistent torsion of the splenic pedicle results in splenic infarction. Ultrasonography, computed tomography, and magnetic resonance imaging are modalities that may be used in diagnosis. The treatment of choice is surgery, with splenectomy or splenopexy, the latter being preferred. CASE REPORT The patient was a 38-year-old woman with a 10-day history of left-sided abdominal pain. Imaging demonstrated a wandering spleen with partial infarction of the inferior pole. An open partial splenectomy with splenopexy of the remaining spleen was performed with the use of an absorbable mesh sutured to the abdominal wall and stomach. Her recovery was uneventful and on follow-up she had no signs of recurrence or complications. CONCLUSION Wandering spleen should be considered in cases of acute abdominal pain, and surgery is the treatment of choice, with the goal of preservation of the organ whenever possible.
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