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Zayed A, Samara E, Shubietah A, Awwad A, Zakaria Z, Daraghma R, Hajhamad M. Delayed presentation of splenic laceration in a postpartum patient: a case of wandering spleen. J Surg Case Rep 2024; 2024:rjae499. [PMID: 39119536 PMCID: PMC11308933 DOI: 10.1093/jscr/rjae499] [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: 05/18/2024] [Revised: 07/03/2024] [Accepted: 07/27/2024] [Indexed: 08/10/2024] Open
Abstract
Wandering spleen (WS) is a rare condition where the spleen is abnormally mobile due to lax or poorly developed ligaments, leading to complications like torsion and laceration after trauma. We describe a case of a 31-year-old postpartum female who presented with severe abdominal pain following blunt trauma. Diagnostics showed an enlarged, ectopic spleen, and significant hematoma. Surgical exploration revealed a 10-cm splenic laceration, necessitating a splenectomy due to extensive blood loss and organ damage. This case highlights the challenges of diagnosing WS, particularly in postpartum patients with increased ligamentous laxity, emphasizing the need for vigilant monitoring and potentially preventive surgical measures to manage this complex condition effectively.
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Affiliation(s)
- Alaa Zayed
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Enas Samara
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdalhakim Shubietah
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Ahmad Awwad
- Emergency Department, Rafidia Government Surgical Hospital, Nablus, Palestine
| | - Zaid Zakaria
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Rawan Daraghma
- Anesthesia Department, Specialized Arab Hospital, Nablus, Palestine
| | - Mohammed Hajhamad
- Department of Surgery, Rafidia Government Surgical Hospital, Nablus, Palestine
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Lakmal K, Nagasinghe SU, Niruban G, Chandraguptha MR, Kalaiyukan S, Wijesinghe K, Nandasena M. Volvulus of a wandering enlarged pelvic spleen involving pancreatic tail: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231205812. [PMID: 37860287 PMCID: PMC10583505 DOI: 10.1177/2050313x231205812] [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: 07/15/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Splenic volvulus of wandering spleen is a rare clinical condition. It causes significant morbidity and mortality, especially if undetected. Here, we report a case of 32-year-old female who presented with worsening abdominal pain for 1-week duration. Contrast-enhanced computed tomography scan of the abdomen showed splenic volvulus with infarction and involvement of the pancreatic tail. She underwent exploratory laparotomy and splenectomy with preservation of the pancreatic tail. Patient progressed favourably. Our case report describes a rare clinical entity of a splenic volvulus with a twisted pancreatic tail. This is a life-threatening condition that requires prompt diagnosis and treatment.
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Affiliation(s)
- Kasun Lakmal
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Shalika Upendra Nagasinghe
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Ganesarajah Niruban
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | | | - Sathasivam Kalaiyukan
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Kanchana Wijesinghe
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - Malith Nandasena
- Department of Surgery, Faculty of Medicine, University of Sri Jayawardenepura, Gangodawila, Nugegoda, Sri Lanka
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Zhu XY, Ji DX, Shi WZ, Fu YW, Zhang DK. Wandering spleen torsion with portal vein thrombosis: A case report. World J Clin Cases 2023; 11:6955-6960. [PMID: 37901012 PMCID: PMC10600865 DOI: 10.12998/wjcc.v11.i28.6955] [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: 07/28/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Wandering spleen is rare clinically. It is characterized by displacement of the spleen in the abdominal and pelvic cavities and can have congenital or acquired causes. Wandering spleen involves serious complications, such as spleen torsion. The clinical symptoms range from asymptomatic abdominal mass to acute abdominal pain. Surgery is required after diagnosis. Cases of wandering spleen torsion with portal vein thrombosis (PVT) are rare. There is no report on how to eliminate PVT in such cases. CASE SUMMARY Ultrasound and computed tomography revealed a diagnosis of wandering spleen torsion with PVT in a 31-year-old woman with a history of childbirth 16 mo previously who received emergency treatment for upper abdominal pain. She recovered well after splenectomy and portal vein thrombectomy combined with continuous anticoagulation, and the PVT disappeared. CONCLUSION Rare and nonspecific conditions, such as wandering splenic torsion with PVT, must be diagnosed and treated early. Patients with complete splenic infarction require splenectomy. Anticoagulation therapy and individualized management for PVT is feasible.
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Affiliation(s)
- Xin-Yan Zhu
- Department of Ultrasound, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
- Department of Ultrasound, Peking University International Hospital, Beijing 102206, China
| | - Dong-Xu Ji
- Department of Radiology, Peking University International Hospital, Beijing 102206, China
| | - Wen-Zai Shi
- Department of Hepatobiliary Surgery, Peking University International Hospital, Beijing 102206, China
| | - Yu-Wei Fu
- Department of Ultrasound, Peking University International Hospital, Beijing 102206, China
| | - Da-Kun Zhang
- Department of Ultrasound, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
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Ahmad H, Hamdar H, Nahle AA, Martini N, Alkhatib Z. A wandering spleen with 720° torsion and persistent ascending and descending mesocolon in a 5-year-old Syrian male: A case report. Int J Surg Case Rep 2023; 107:108319. [PMID: 37263001 DOI: 10.1016/j.ijscr.2023.108319] [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: 04/17/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The spleen is normally found in the left hypochondrium and it is fixed in its place by numerous suspensory ligaments. When the ligaments are elongated or abnormally developed, it causes a rare medical condition called Wandering spleen. A persistent ascending and descending mesocolon is also a congenital anomaly, resulting from the failure of fusion of the primitive dorsal mesocolon. CASE PRESENTATION Herein, a 5-year-old male child with sudden and acute onset of abdominal pain, constipation, nausea, tachycardia, and low urine output, imaging and blood tests revealed evidence of intestinal obstruction and normocytic anemia and neutrophilia. A laparotomy revealed persistent ascending and descending mesocolon, with a torsioned vascular pedicle of the spleen, resulting in splenomegaly and infarction. The surgeon successfully derotated the torsioned pedicle and performed a splenectomy. The patient had an uneventful postoperative course and was discharged without complications. CLINICAL DISCUSSION This case could be asymptomatic and the diagnosis is incidental or it could be presented with ambiguous symptoms. The differential diagnosis of WS varies according to the clinical presentation and the associated complication. For instance, in the case of WS torsion and acute presentation, the differential diagnosis is ovarian torsion, acute appendicitis, and intestinal obstruction. Currently, surgery is the only suggested treatment option even in asymptomatic patients as well. CONCLUSION This case of a Wandering Spleen is associated with a persistent ascending and descending mesocolon, suggesting that there may be certain risk factors. Therefore, we suggest making more research about wandering spleen in association with persistent mesocolon.
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Affiliation(s)
- Hiyam Ahmad
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Hussein Hamdar
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Ali Alakbar Nahle
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic
| | - Nafiza Martini
- Damascus University, Faculty of Medicine, Damascus, Syrian Arab Republic; Stemosis for Scientific Research, Damascus, Syrian Arab Republic.
| | - Zaed Alkhatib
- Ibn Al-Nafees Hospital, Damascus, Syrian Arab Republic
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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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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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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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Giraud JT, Dingremont C, Gailleton R, Tissier M, Arouch K. [A case report of wandering spleen]. Rev Med Interne 2020; 42:285-287. [PMID: 33341287 DOI: 10.1016/j.revmed.2020.11.010] [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: 07/24/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Wandering spleen is a rare condition that occurs when there is an acquired or congenital hypelaxity of the suspensory ligaments of the spleen, resulting in its migration to any abdominal or pelvic position. CASE REPORT A 43-year-old woman presented with symptoms of acute abdominal pain. At physical examination, a splenomegaly was found in the left hypochondria, thereafter followed by a secondary migration of the lump to a periumbilical location. Computed tomography revealed a wandering spleen with vascular pedicle torsion. Splenopexia was perfomed. CONCLUSION A wandering spleen is most frequently observed in children and young women. This rare diagnosis should be considered facing a recurrent abdominal pain syndrome, a splenomegaly accompanied with pain, or a pelvic lump. A wandering spleen may lead to torsion of the vascular pedicle of the spleen, a chronic volvulus with portal hypertension, or even a splenic infarction. The diagnosis is performed by computed tomography. Wandering spleen is treated surgically, by splenopexy or splenectomy.
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Affiliation(s)
- J-T Giraud
- Service de médecine interne, centre hospitalier de Bigorre, 65000 Tarbes, France.
| | - C Dingremont
- Service de médecine interne, centre hospitalier de Bigorre, 65000 Tarbes, France
| | - R Gailleton
- Service de chirurgie digestive, centre hospitalier de Bigorre, 65000 Tarbes, France
| | - M Tissier
- Service d'imagerie médicale, centre hospitalier de Bigorre, 65000 Tarbes, France
| | - K Arouch
- Service d'imagerie médicale, centre hospitalier de Bigorre, 65000 Tarbes, France
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Koliakos E, Papazarkadas X, Sleiman MJ, Rotas I, Christodoulou M. Wandering Spleen Volvulus: A Case Report and Literature Review of This Diagnostic Challenge. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925301. [PMID: 32868755 PMCID: PMC7483514 DOI: 10.12659/ajcr.925301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Wandering spleen is a rare condition in which the spleen lacks the usual peritoneal attachments, resulting in increased intra-abdominal mobility. Complications can occur due to the torsion of the splenic vascular pedicle, resulting in symptoms ranging from an incidental finding to an acute abdomen as a result of an ischemic necrosis of the spleen. CASE REPORT We present the case of a 25-year-old female patient who presented with a recurring abdominal pain associated with serum lipase and C-reactive protein elevation. The computed tomography scan revealed torsion of the splenic pedicle and hypoperfusion of the spleen. A surgical exploration was performed and a wandering spleen was diagnosed perioperatively. It was characterized by the lack of peritoneal ligaments, thus resulting in a splenic volvulus. A splenectomy was carried out due to the definite ischemic necrosis of the spleen. CONCLUSIONS The diagnosis of this rare condition can be very challenging since it can be presented with a vast variety of symptoms, mimicking other abdominal pathologies. The intermittent nature of an ultimate splenic torsion can add to the diagnostic challenge. Medical literature concerning the wandering spleen and knowledge about this pathology originates mainly from individual case reports. Despite the evolving diagnostic modalities available, this rare and ambiguous disorder remains misdiagnosed, and a high index of suspicion is needed for the appropriate diagnosis to be established.
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Affiliation(s)
- Evangelos Koliakos
- Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | | | | | - Ioannis Rotas
- Department of General Surgery, Hospital of Valais (CHVR), Sion, Switzerland
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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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Colombo F, D'Amore P, Crespi M, Sampietro G, Foschi D. Torsion of wandering spleen involving the pancreatic tail. Ann Med Surg (Lond) 2019; 50:10-13. [PMID: 32021685 PMCID: PMC6994766 DOI: 10.1016/j.amsu.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022] Open
Abstract
Background Wandering spleen (WS) is a rare clinical entity resulting from the absence or maldevelopment of the ligaments normally involved in the attachment of the spleen in its normal position. WS can be a cause of acute abdomen leading to different complications ranging from torsion of the vascular pedicle to spleen infarction. Often, in absence of symptoms, it is an occasional finding during radiological exams and surgery represents the gold standard in the management of this unusual condition. Case presentation We present a case of wandering spleen in a young nulliparous female with an history of recurrent abdominal pain. A preoperative CT-scan of the abdomen showed the presence of a multi-infarcted spleen twisted several times around its vascular pedicle, involving the tail of pancreas. The patient was electively treated with laparoscopic splenectomy. Conclusions A laparoscopic approach is feasible in the treatment of this pathology. A correct and timely diagnosis of this condition is crucial to allow an organ preserving surgery. There are only few reported cases in literature describing an involvement of the tail of the pancreas in the torsion of the vascular pedicle. Complete excision of the ectasic veins tributaries of the splenic vein avoids the risk of postoperative vein thrombosis and bleeding.
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Affiliation(s)
- Francesco Colombo
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
| | - Pierluigi D'Amore
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
| | - Michele Crespi
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
| | - Gianluca Sampietro
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
| | - Diego Foschi
- Department of Biomedical and Clinical Sciences, L. Sacco Hospital University of Milan, Italy
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12
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Han J, Tonkin D, Hewett P. Rare case of wandering spleen causing intra‐thoracic megacolon. ANZ J Surg 2019; 90:1192-1193. [DOI: 10.1111/ans.15542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jennie Han
- Department of SurgeryRoyal Adelaide Hospital Adelaide South Australia Australia
- Department of SurgeryQueen Elizabeth Hospital Adelaide South Australia Australia
| | - Darren Tonkin
- Department of SurgeryQueen Elizabeth Hospital Adelaide South Australia Australia
| | - Peter Hewett
- Department of SurgeryQueen Elizabeth Hospital Adelaide South Australia Australia
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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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14
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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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15
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Splenic torsion presenting as splenic vein thrombosis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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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Urbonas T, Crotty FE, Al-Bahrani A. Torsion of an ectopic spleen: a possible late complication of paraoesophageal hernia repair. ANZ J Surg 2015; 88:E357-E358. [PMID: 26489700 DOI: 10.1111/ans.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tomas Urbonas
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
| | - Fiona E Crotty
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
| | - Ahmed Al-Bahrani
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
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18
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Karakus SC, Kilincaslan H, Koku N. An etiologic dilemma of wandering spleen in childhood: is it congenital or acquired? Indian J Pediatr 2014; 81:1411-2. [PMID: 24710711 DOI: 10.1007/s12098-014-1435-2] [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: 12/23/2013] [Accepted: 03/20/2014] [Indexed: 11/30/2022]
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19
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Blouhos K, Boulas KA, Salpigktidis I, Barettas N, Hatzigeorgiadis A. Ectopic spleen: An easily identifiable but commonly undiagnosed entity until manifestation of complications. Int J Surg Case Rep 2014; 5:451-4. [PMID: 24973525 PMCID: PMC4147574 DOI: 10.1016/j.ijscr.2014.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/14/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Ectopic spleen is an uncommon clinical entity as splenectomy for treatment of ectopic spleens accounts for less than 0.25% of splenectomies. The most common age of presentation is childhood especially under 1 year of age followed by the third decade of life. PRESENTATION OF CASE The present report refers to a patient with torsion of a pelvic spleen treated with splenectomy. The patient exhibited a period of vague intermittent lower abdominal pain lasted 65 days followed by a period of constant left lower quadrant pain of increasing severity lasted 6 days. On the first 65 days, vague pain was attributed to progressive torsion of the spleen which resulted in venous congestion. On the last 6 days, exacerbation of pain was attributed to irreducible torsion, infraction of the arterial supply, acute ischemia, strangulation and rupture of the gangrenous spleen. Diagnosis was made by CT which revealed absence of the spleen in its normal position, a homogeneous pelvic mass with no contrast enhancement, free blood in the peritoneal cavity, and confirmed by laparotomy. DISCUSSION Clinical manifestations of ectopic spleen vary from asymptomatic to abdominal emergency. Symptoms are most commonly attributed to complications related to torsion. Operative management, including splenopexy or splenectomy, is the treatment of choice in uncomplicated and complicated cases because conservative treatment of an asymptomatic ectopic spleen is associated with a complication rate of 65%. CONCLUSION Although an ectopic spleen can be easily identified on clinical examination, it is commonly misdiagnosed until the manifestation of complications in adulthood.
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Affiliation(s)
| | | | - Ilias Salpigktidis
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
| | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
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20
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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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21
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Gu J, Elston T, Robson A. Acute torsion of a wandering spleen. ANZ J Surg 2014; 85:789-90. [PMID: 24612438 DOI: 10.1111/ans.12551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jennie Gu
- Department of General Surgery, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Timothy Elston
- Department of General Surgery, Cairns Base Hospital, Cairns, Queensland, Australia
| | - Angela Robson
- Department of General Surgery, Cairns Base Hospital, Cairns, Queensland, Australia
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22
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Sheikh F, Kim ME, Zamora IJ, Olutoye OO. Non-operative management of a rare diagnosis of splenic torsion in a child with a history of giant omphalocele: a case report and literature review. Patient Saf Surg 2014; 8:12. [PMID: 24602190 PMCID: PMC3973840 DOI: 10.1186/1754-9493-8-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Splenic torsion is rare and as a result the appropriate management is unclear. While there has been a shift towards splenectomy and laparoscopic splenopexy, we present a successful case of non-operative management of splenic torsion in a patient with a history of a giant omphalocele. CASE PRESENTATION A 3 year-old female presented with a three-day history of abdominal pain, fever and non-bloody emesis three and a half years after repair of her giant omphalocele. Abdominal radiographs and ultrasound demonstrated migration of the spleen and a subsequent computerized tomography scan confirmed splenic torsion and an infarcted spleen. Given her late presentation, she was successfully managed with observation, analgesia, immunization against capsulated organisms and daily penicillin prophylaxis with excellent outcome at 19 months follow-up. A review of the literature revealed that splenic torsion is rarely managed non-operatively. Rarer still is the occurrence of splenic torsion following a history of omphalocele. CONCLUSION Although rare, splenic torsion should be considered in a child with a history of omphalocele presenting with abdominal pain. Non-operative management of an infarcted spleen can be a safe treatment option to avoid surgery in complex patients.
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Affiliation(s)
| | | | | | - Oluyinka O Olutoye
- Division of Pediatric Surgery, Michael E DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston TX, USA.
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23
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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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24
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Mehta A, Vana PG, Glynn L. Splenic torsion after congenital diaphragmatic hernia repair: case report and review of the literature. J Pediatr Surg 2013; 48:e29-31. [PMID: 23480945 DOI: 10.1016/j.jpedsurg.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
Wandering spleen with torsion, a rare clinical diagnosis, was found to be the cause of chronic abdominal pain in an 11-year-old female with a history of congenital diaphragmatic hernia repaired at three days of age. Doppler ultrasound revealed patent vessels with splenomegaly, and computed tomography (CT) showed an absence of the spleen in the left subphrenic space with torsion at the splenic hilum. Due to the chronicity of pain and risk of ischemia from torsion, open splenopexy with Vicryl mesh was performed. This case report/review of the literature discusses the rarity of this condition, and the importance of timely diagnosis and intervention.
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Affiliation(s)
- Anupama Mehta
- Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
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25
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Le K, Griner D, Hope WW, Tackett D. Splenic torsion requiring splenectomy six years following laparoscopic Nissen fundoplication. JSLS 2012; 16:184-8. [PMID: 22906354 PMCID: PMC3407447 DOI: 10.4293/108680812x13291597716861] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Laparoscopic Nissen fundoplication has become a mainstay in the surgical treatment of gastroesophageal reflux disease, as it has proved to be a durable, well-tolerated procedure. Despite the safety and efficacy associated with this procedure, surgeons performing this advanced laparoscopic surgery should be well versed in the potential intraoperative and postoperative complications. METHODS A case is presented of a rare complication of splenic torsion following laparoscopic Nissen fundoplication. Diagnostic evaluations and intraoperative findings are discussed. RESULTS We present an otherwise healthy 41-year-old woman who underwent a laparoscopic Nissen fundoplication 6 years earlier at another medical center and presented with worsening chronic left upper quadrant abdominal pain. She was diagnosed with torsion of the splenic vascular pedicle, resulting in heterogenicity of perfusion with associated hematoma requiring open splenectomy. CONCLUSION Surgeons should be aware of splenic torsion as a potential, albeit rare, complication related to laparoscopic Nissen fundoplication.
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Affiliation(s)
- Khoi Le
- South East Area Health Education Center, Department of Surgery, New Hanover Regional Medical Center, Wilmington, NC, USA
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26
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Laparoscopic splenectomy for the treatment of wandering spleen in a pregnant woman: a case report. Surg Laparosc Endosc Percutan Tech 2012; 22:e102-4. [PMID: 22487633 DOI: 10.1097/sle.0b013e318246beb5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Laparoscopic splenectomy became the gold standard recently for the removal of spleen. One of its rare indication is wandering spleen (WS). WS is characterized by incomplete fixation of the spleen. Patients usually have an asymptomatic abdominal mass. When they are symptomatic, abdominal pain with a mobile mass is the major finding. Laboratory data are nonspecific, but the diagnosis can be confirmed by imaging studies; computed tomography, magnetic resonance imaging, and ultrasonography are preferred modalities. It can predispose one to life-threatening complications such as splenic infarction, portal hypertension, pancretitis, and hemorrhage, due to torsion of its vascular pedicle. Herein, we present a female patient, a 24-year-old, 18-week primigravida. She was admitted with an intra-abdominal mass and lower abdominal pain. Ultrasonography revealed a mass behind the uterus. Magnetic resonance imaging was planned, and the spleen was seen at this area. We performed laparoscopic splenectomy for the treatment of a WS, which would be dangerous for pregnancy. The patient was discharged without any postoperative complication on the third day postoperatively. A healthy baby was delivered at term. Minimally invasive procedures should also be the primary choice in the treatment of such pregnant women. This is the first case of laparoscopic splenectomy in a pregnant woman for WS in the English literature.
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27
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28
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Ugwu AC, Ogbonna CO, Imo AO. A wandering spleen: A common presentation of an uncommon anomaly. S Afr Fam Pract (2004) 2010. [DOI: 10.1080/20786204.2010.10873930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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29
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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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30
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Sarría Octavio de Toledo L, Cozcolluela Cabrejas R, García Asensio S, Martínez-Berganza T. [Wandering spleen associated to inflammatory pseudotumor]. RADIOLOGIA 2006; 48:173-6. [PMID: 17058642 DOI: 10.1016/s0033-8338(06)73149-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor.
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31
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Castellón-Pavón CJ, Valderrábano-González S, Anchústegui-Melgarejo P, Alvarez-Alvarez J, Morales-Artero S, Pérez-Algar C, Corrales-Castillo S, García-Serrano FR. Esplenectomía laparoscópica por torsión de un bazo ectópico (wandering spleen). Cir Esp 2006; 80:406-8. [PMID: 17192227 DOI: 10.1016/s0009-739x(06)70996-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Wandering spleen is an uncommon entity, characterized by the anomalous position of the spleen, caused by the absence or laxity of its suspensory ligaments. The most common symptoms are usually due to intermittent or complete torsion of the splenic pedicle with subsequent infarction. We report a case of torsion of a wandering spleen. Laparoscopic splenectomy was performed and recovery was uneventful. Although few cases of wandering spleen treated laparoscopically have been reported in the literature, laparoscopy has been demonstrated to be a safe technique for the treatment of this entity.
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32
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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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33
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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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34
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Lu CC, Chen HH, Hsieh MJ. Wandering Spleen Presenting as Gastric Outlet Obstruction after Repair of Traumatic Diaphragmatic Hernia. ACTA ACUST UNITED AC 2004; 56:431-2. [PMID: 14960990 DOI: 10.1097/01.ta.0000033501.57290.ad] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chien-Chang Lu
- Department of Colorectal Surgery, Chag Gung Memorial Hospital Kaohsiung Medical Center, Kaohsiung, Taiwan
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35
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Abstract
Torsion of a wandering spleen is a rare cause of abdominal pain in children. The most common presentation is acute abdominal pain, although signs and symptoms vary widely. Due to the risk of splenic infarction, rapid and accurate diagnosis is essential. Wandering spleen and splenic torsion can be diagnosed by Doppler ultrasound and CT scan. Treatment options include splenopexy or splenectomy. This case describes a 9-year-old girl with torsion of a wandering spleen, complicated by splenic infarction and managed by splenectomy.
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Affiliation(s)
- Jennifer R Romero
- Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213-2583, USA
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36
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Brown CVR, Virgilio GR, Vazquez WD. Wandering spleen and its complications in children: a case series and review of the literature. J Pediatr Surg 2003; 38:1676-9. [PMID: 14614725 DOI: 10.1016/s0022-3468(03)00582-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Wandering spleen is an uncommon clinical entity, which rarely affects children and adolescents. It is usually described in adults, especially women of childbearing age. Discussion in the literature has been limited to case reports and small case series. Here the authors present 2 children and 1 adolescent that presented to the authors institution over a 9-month period with complications from a wandering spleen. All 3 patients had very different clinical presentations, and this variety is a constant theme throughout the literature. We also identified an additional 127 cases of wandering spleen in patients younger than 21 years. In this report we discuss the clinical presentations, diagnostic evaluation, treatment options, and clinical outcomes as they relate to wandering spleen.
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Affiliation(s)
- Carlos V R Brown
- Division of Pediatric Surgery, Naval Medical Center, San Diego, CA 92134, USA
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37
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Moran JC, Shah U, Singer JA. Spontaneous rupture of a wandering spleen: case report and literature review. ACTA ACUST UNITED AC 2003; 60:310-2. [PMID: 14972263 DOI: 10.1016/s0149-7944(02)00737-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Wandering spleen is a rare clinical entity. The etiology is not precisely known, and the management is controversial. Patients may become symptomatic when torsion of the pedicle results in pain, ischemia, infarction, or rupture. We present a spontaneous rupture of a wandering spleen without any history of trauma.
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Affiliation(s)
- Joseph C Moran
- Department of Surgery, St. Agnes HealthCare, Inc., Baltimore, Maryland 21229, USA
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38
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d'Halluin G, Menard J, Dessard P, Dauphin H, Deshayes M, Pierre F, Magnin G. [Torsion of the accessory spleen: an atypical etiology for acute abdomen]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2001; 29:821-3. [PMID: 11770276 DOI: 10.1016/s1297-9589(01)00226-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The accessory spleen is often a incidental discovery. The accessory post-accidental spleen are unusual. The torsion of a movable spleen is possible and represent about 0.2 to 0.3% of splenectomy. But the torsion of an accessory spleen is exceptional. A case of acute torsion of an accessory spleen is reported. In a 26-year-old women was admitted with acute abdominal pain. The abdominal ultrasound and the abdominal X-Ray are no specific. In the face of the acute pain, a laparoscopy was necessary. At laparoscopy, the patient was found to have torsion and infarction of an accessory spleen in the pelvis. The treatment was a splenectomy and the evolution was favorable.
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Affiliation(s)
- G d'Halluin
- Service de gynécologie, obstétrique et biologie de la reproduction, CHU de Poitiers, rue de la Milétrie, BP 577, 86021 Poitiers, France.
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39
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Zimmermann ME, Cohen RC. Wandering spleen presenting as an asymptomatic mass. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 2000; 70:904-6. [PMID: 11167584 DOI: 10.1046/j.1440-1622.2000.02008.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- M E Zimmermann
- Royal Alexandra Hospital for Children, Sydney, New South Wales, Australia
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40
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Haj M, Bickel A, Weiss M, Eitan A. Laparoscopic splenopexy of a wandering spleen. J Laparoendosc Adv Surg Tech A 1999; 9:357-60. [PMID: 10488833 DOI: 10.1089/lap.1999.9.357] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A laparoscopic technique for splenopexy of a wandering spleen using an absorbable mesh in an adult woman is described for the first time. This patient was referred to surgery because of recurrent biliary colic secondary to cholecystolithiasis. The wandering spleen had been diagnosed at least 4 years earlier, but a conservative approach had been adopted for a symptomless patient. Laparoscopic cholecystectomy was performed concomitantly with splenopexy. Laparoscopic splenopexy seems a feasible and safe procedure, especially when performed by experienced laparoscopic surgeons.
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Affiliation(s)
- M Haj
- Department of Surgery, Western Galilee Hospital, Nahariya, Haifa, Israel
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41
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Affiliation(s)
- T M Lane
- Department of Surgery, Maidstone Hospital, UK
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42
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43
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Sarimurat N, Tekant GT, Hüseyin S, Söylet Y, Senyüz OF. Wandering spleen in childhood: a report of three cases. Surg Today 1997; 27:1086-8. [PMID: 9413067 DOI: 10.1007/bf02385795] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Wandering spleen is a rare cause of abdominal pain in children, and an accurate diagnosis is seldom made preoperatively. A splenectomy is the treatment of choice in cases of splenic torsion and infarction, while in patients with chronic symptoms splenopexy may also be attempted. We herein report three patients with wandering spleen, of whom two presented with acute torsion of the splenic pedicle and one demonstrated an asymptomatic mobile abdominal mass. In the first case splenopexy was attempted, but during follow-up the spleen was found to have undergone atrophy. The presentation, diagnostic procedures, and treatment modalities in pediatric wandering spleen are reviewed.
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Affiliation(s)
- N Sarimurat
- Department of Pediatric Surgery, Cerrahpaşa Medical Faculty of Istanbul University, Turkey
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44
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Ng T, Lessin MS, Luks FI, Wallach MT, Wesselhoeft CW. Wandering spleen presenting as duodenal obstruction after repair of congenital diaphragmatic hernia. J Pediatr Surg 1997; 32:1790-2. [PMID: 9434030 DOI: 10.1016/s0022-3468(97)90537-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The most common presentation of the wandering spleen in children is torsion with infarction. Duodenal obstruction by the spleen has not been reported previously. Wandering spleen can accompany congenital diaphragmatic hernia (CDH) because of its loss of retroperitoneal fixation. If absence of normal splenic fixation is found during repair of CDH, splenopexy should be performed to eliminate the risk of torsion, infarction, or, as described here, duodenal obstruction.
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Affiliation(s)
- T Ng
- Division of Pediatric Surgery, Brown University School of Medicine, Hasbro Children's Hospital, Providence, Rhode Island 02905, USA
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45
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Abstract
An ectopic, so-called wandering spleen is an uncommon occurrence. We present the case of a young woman who presented with abdominal pain and was found to have an enlarged spleen, located in the lower abdomen and pelvis. The possibility of lymphoma was entertained because of concomitant findings of thrombocytopenia and a possible mesenteric mass. The mass was subsequently found at laparotomy to be the tail of the malpositioned pancreas, and the thrombocytopenia resolved with splenectomy. Review of the literature indicates that lymphoma is an uncommon finding in wandering spleens, that wandering spleens are enlarged in most cases, and that thrombocytopenia, while uncommon, can be seen, in particular when associated with torsion of an elongated splenic pedicle.
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Affiliation(s)
- S Moll
- Division of Hematology/Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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Horwitz JR, Black CT. Traumatic rupture of a wandering spleen in a child: case report and literature review. THE JOURNAL OF TRAUMA 1996; 41:348-50. [PMID: 8760550 DOI: 10.1097/00005373-199608000-00027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A case of traumatic rupture of a wandering spleen in a 5-year-old girl is presented. To our knowledge, this is the first reported case of such injury in a child. The splenic injury was managed nonoperatively. The etiology and management of wandering spleen is discussed.
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Affiliation(s)
- J R Horwitz
- Department of Surgery, University of Texas Medical School, Houston 77030, USA
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Abstract
A wandering spleen is a rare condition characterized by splenic malposition due to congenital maldevelopment or laxity of the supporting ligamentous structures that usually fixate the anatomical position of the spleen. The diagnosis is often difficult to make clinically. In this report, a case is described in which an In-111 oxime labeled leukocyte scan was helpful in making a diagnosis of a wandering spleen.
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Affiliation(s)
- L F Posillico
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA
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