1
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Comune R, Guida F, Marte G, Diglio D, Nicola R, Bonito G, Tonerini M, Galluzzo M, Scaglione M, Tamburrini S. Gastric outlet obstruction in uncomplicated mesentero-axial gastric volvulus associated to hiatal hernia. Radiol Case Rep 2024; 19:2698-2702. [PMID: 38666144 PMCID: PMC11043781 DOI: 10.1016/j.radcr.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/03/2024] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
Gastric volvulus is a rare condition determined by the rotation of one part of stomach around another. Stomach can rotate around its longitudinal or short axis or both. The presentation can be acute, subacute and chronic due to twisting and untwisting andimaging should be performed in the acute phase. MDCT shows high accuracy in thediagnosis and definition of gastric volvulus being the preferred diagnostic test in emergency settings. Gastric volvulus may be associated or determined by pre-existing hiatal hernia and accurate analysis of CT signs may be evaluated on order to differentiate between a stomach in an abnormal position and a volvulus.At CT, a displaced antrum at the same level or cranial to the fundus and a transition point at the pylorus is diagnostic for mesenteroaxial volvulus. We present a case of a 70 years old woman with mesenteroaxial volvulus in hiatal hernia.
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Affiliation(s)
- Rosita Comune
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Guida
- Department of General and Emergency Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giampaolo Marte
- Department of General and Emergency Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Domenico Diglio
- Department of Radiology Hospital of Marcianise, 81025 Marcianise, Italy
| | - Rosano Nicola
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giacomo Bonito
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Michele Tonerini
- Department of Emergency Radiology, Cisanello Hospital, Via Cisanello, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
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2
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Bhambu SK, Awasthi PK, Mangal R, Mehta R, N S. Acute Gastric Volvulus With Wandering Spleen in a Two-Year-Old Child: A Rare Association. Cureus 2023; 15:e38386. [PMID: 37265917 PMCID: PMC10231407 DOI: 10.7759/cureus.38386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Gastric volvulus is a rare clinical condition characterized by a pathological rotation of the stomach greater than 180º around its axis. The wandering spleen is also an exceptional clinical entity characterized by the absence or laxity of splenic ligaments which lead to splenic mobility in the abdominal cavity from its normal anatomical site. Wandering spleen and gastric volvulus association is unusual. Both can be life-threatening if left untreated. We herein present a rare, unusual association of mesenteroaxial gastric volvulus with wandering spleen in a two-year-old child and interpret the radiological findings to ensure correct and early diagnosis.
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Affiliation(s)
- Sunil Kumar Bhambu
- Radiodiagnosis, Ananta Institute of Medical Sciences & Research Center, Udaipur, IND
| | - Puneet Kumar Awasthi
- Radiodiagnosis, Ananta Institute of Medical Sciences & Research Center, Udaipur, IND
| | - Rahul Mangal
- Radiodiagnosis, Ananta Institute of Medical Sciences & Research Center, Udaipur, IND
| | - Ritu Mehta
- Radiodiagnosis, Ananta Institute of Medical Sciences & Research Center, Udaipur, IND
| | - Shreyas N
- Surgery, Ananta Institute of Medical Sciences & Research Center, Udaipur, IND
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3
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Bhatta NC, Kathayat K, Dahal S, Shrivastava B, Shakya N, Shrestha A, Nepal B, Sthapit R. Gastric volvulus: An uncommon and life threatening cause of acute gastric dilatation in a young male: A case report. Clin Case Rep 2022; 10:e6537. [PMID: 36397851 PMCID: PMC9664528 DOI: 10.1002/ccr3.6537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/17/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
Gastric volvulus leading to acute gastric dilatation is a surgical emergency that should be considered as a differential in patients who present to the emergency department with severe epigastric pain and evidence of gastric outlet obstruction. This condition requires a high index of suspicion that enables early diagnosis and treatment.
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Affiliation(s)
- Naveen Chandra Bhatta
- Department of General SurgeryNational Academy of Medical Sciences, Bir HospitalKathmanduNepal
| | | | | | - Bijay Shrivastava
- Department of General SurgeryNational Academy of Medical Sciences, Bir HospitalKathmanduNepal
| | - Niliza Shakya
- Department of General SurgeryNational Academy of Medical Sciences, Bir HospitalKathmanduNepal
| | - Asish Shrestha
- Department of General SurgeryNational Academy of Medical Sciences, Bir HospitalKathmanduNepal
| | - Bikash Nepal
- Department of General SurgeryNational Academy of Medical Sciences, Bir HospitalKathmanduNepal
| | - Rakesh Sthapit
- Department of General SurgeryNational Academy of Medical Sciences, Bir HospitalKathmanduNepal
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4
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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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5
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Yokoyama K, Yano T, Kumagai H, Okada Y, Hashimoto Y, Ono S, Lefor AK, Yamagata T. Reduction of acute gastric volvulus in a 3-year-old using a balloon-attached endoscope combined with gel immersion endoscopy. Clin J Gastroenterol 2022; 15:95-100. [PMID: 35000121 DOI: 10.1007/s12328-021-01566-5] [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] [Received: 09/24/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
When performing endoscopic reduction in patients with gastric volvulus, it is important to maintain a low level of intragastric pressure and to fix the endoscope in the duodenum. Gel immersion endoscopy is a new method for securing the visual field by injecting clear gel. The balloon-attached endoscope makes it easier to fix the tip in the duodenum without mucosal damage. We report successful reduction of a mesenteroaxial gastric volvulus using an endoscope with a balloon in combination with gel immersion endoscopy. A 3-year-old Japanese male developed gastric volvulus. Since gastric decompression using a nasogastric tube failed to reduce the volvulus, endoscopic reduction was performed under general anesthesia. After aspiration of intragastric gas, clear gel was injected through the accessory channel which secured the visual field in the stomach even with residue while maintaining low intragastric pressure. After reaching the descending portion of the duodenum, the balloon attached to the tip of the endoscope was inflated and fixed in the duodenum. The volvulus was successfully reduced by pulling back the endoscope with clockwise torque. Acute mesenteroaxial gastric volvulus has the potential to cause ischemia and perforation which can be life-threatening, so most patients are treated with surgical intervention. Gel immersion endoscopy is safe and effective to secure the visual field, even in children. Endoscopic reduction may be a viable treatment option for reducing gastric volvulus in non-emergent patients.
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Affiliation(s)
- Koji Yokoyama
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan.
| | - Tomonori Yano
- Department of Internal Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yuko Okada
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Yusuke Hashimoto
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shigeru Ono
- Department of Pediatric Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takanori Yamagata
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
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6
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Miura Y, Otsuka R, Arita A, Ishida Y. Adult primary gastric volvulus, a report of two cases. AME Case Rep 2019; 3:43. [PMID: 31872178 DOI: 10.21037/acr.2019.10.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/19/2019] [Indexed: 11/06/2022]
Abstract
Gastric volvulus is the medical situation that a stomach is twisted beyond the physiological range. It is a rare disease which is hard to experience in routine medical examination. Principally surgical treatment is essential for the acute type. However, the conservative therapy should be attempted in some cases, such as decompression of a stomach with a nasogastric tube, endoscopic reduction and so forth. Concerning surgical operation, the base is reduction of the torsion and immobilization of stomach. Recently, laparoscopic surgery is performed for the case that the general condition is stable or chronically progressive in the early stages. Percutaneous endoscopic gastrostomy (PEG) had also been performed for gastric immobilization. However, the recurrences and problems of twisting around the gastrostomy site were reported in addition to the problem of cosmetic outcomes. Therefore, the case is decreasing. In this paper, we present two cases on adult primary gastric volvulus. For the first case, endoscopic reduction was not good enough to release the torsion state. Then laparoscopic gastropexy was performed successfully. For the second case, we succeeded in endoscopic reduction. Since the patient had already experienced gastric volvulus, laparoscopic surgery was performed. The upper and middle gastric bodies were secured to the anterior abdominal wall, and gastric antrum to the ligamentum teres hepatis with interrupted absorbable sutures respectively. However, partial gastric volvulus recurred after ten and a several days postoperatively due to cutting off of the suture at the antrum secured to the ligamentum teres hepatis at previous surgery. Then, PEG for 2 points of lower body and antrum were performed to secure the antrum. The gastrostomies were removed 6 months after the surgery. Immobilization by laparoscopic gastropexy and PEG are useful for gastric volvulus due to their significant merit of minimum invasiveness. Concerning gastropexy, the number of sutures is very important for the secured part not to be torn off.
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Affiliation(s)
- Yasuaki Miura
- Department of Surgery, Higashitotsuka Memorial Hospital, Yokohama, Japan
| | - Ryo Otsuka
- Department of Surgery, Yokohama Shin-midori General Hospital, Yokohama, Japan
| | - Atsushi Arita
- Department of Surgery, Higashitotsuka Memorial Hospital, Yokohama, Japan
| | - Yasuo Ishida
- Department of Surgery, Yokohama Asahi-Chuo General Hospital, Yokohama, Japan
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7
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Asafu Adjaye Frimpong G, Aboagye E, Ayisi-Boateng NK, Antwi K, Bawuah KA, Coleman NE, Nunoo AW, Danso DB, Amoah M, Kwofie B. Concurrent occurrence of a wandering spleen, organoaxial gastric volvulus, pancreatic volvulus, and cholestasis - A rare cause of an acute abdomen. Radiol Case Rep 2019; 14:946-951. [PMID: 31193859 PMCID: PMC6543132 DOI: 10.1016/j.radcr.2019.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
The concurrence of wandering spleen, organoaxial gastric volvulus, and pancreatic volvulus is very rare. They have been associated with symptoms such as severe abdominal pain, abdominal distention, and vomiting. However, the diagnosis remains complicated and any delay can result in ischemia and necrosis of the organs involved. In this case presentation, we present a unique case involving a 14-year-old girl who presented initially with acute abdominal pain. Assessment with enhanced computed tomography scan led to the diagnosis of wandering spleen, organoaxial gastric volvulus, and pancreatic volvulus, in addition to cholestasis, making it the first study to report on the simultaneous occurrence of this triad and cholestasis.
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Affiliation(s)
- George Asafu Adjaye Frimpong
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana.,Department of Radiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - E Aboagye
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana
| | - N K Ayisi-Boateng
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - K Antwi
- County Hospital, Kumasi, Ghana
| | - K A Bawuah
- Department of Radiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - N E Coleman
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana
| | - A W Nunoo
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana
| | - D B Danso
- Spectra Health Imaging and Interventional Radiology Centre, Post Office Box, Kumasi KS 5431, Ghana
| | - M Amoah
- County Hospital, Kumasi, Ghana
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8
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Akhtar A, Siddiqui FS, Sheikh AAE, Sheikh AB, Perisetti A. Gastric Volvulus: A Rare Entity Case Report and Literature Review. Cureus 2018; 10:e2312. [PMID: 29755908 PMCID: PMC5947932 DOI: 10.7759/cureus.2312] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Gastric volvulus is a rare entity defined as an abnormal rotation of the stomach around itself. It is a diagnosis of exclusion; the clinical index of suspicion is always low and is mostly diagnosed on imaging or on the surgery table. When it occurs, it is an emergency due to the risk of strangulation and consequent gangrene of the stomach. Mesentero-axial (MA) gastric volvuli constitute one-third of all cases. Here, we are present an interesting case of acute MA gastric volvulus diagnosed with imaging and treated subsequently.
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Affiliation(s)
- Aisha Akhtar
- Department of Surgery, Texas Tech University Health Sciences Center
| | | | | | | | - Abhilash Perisetti
- Department of Hospital Medicine, Texas Tech University Health Sciences Center
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9
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Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature. Case Rep Surg 2016; 2016:6450765. [PMID: 27703832 PMCID: PMC5039297 DOI: 10.1155/2016/6450765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/18/2016] [Indexed: 01/25/2023] Open
Abstract
Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia.
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10
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Omata J, Utsunomiya K, Kajiwara Y, Takahata R, Miyasaka N, Sugasawa H, Sakamoto N, Yamagishi Y, Fukumura M, Kitagawa D, Konno M, Okusa Y, Murayama M. Acute gastric volvulus associated with wandering spleen in an adult treated laparoscopically after endoscopic reduction: a case report. Surg Case Rep 2016; 2:47. [PMID: 27221130 PMCID: PMC4879081 DOI: 10.1186/s40792-016-0175-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 05/21/2016] [Indexed: 11/30/2022] Open
Abstract
A 43-year-old female was referred to our hospital for sudden onset of abdominal pain, fullness, and vomiting. Physical examination revealed abdominal distension with mild epigastric tenderness. Abdominal radiography showed massive gastric distension and plain computed tomography (CT) a markedly enlarged stomach filled with gas and fluid. A large volume of gastric contents was suctioned out via a nasogastric (NG) tube. Contrast-enhanced CT showed a grossly distended stomach with displacement of the antrum above the gastroesophageal junction, and the spleen was dislocated inferiorly. Upper gastrointestinal (GI) series showed the greater curvature to be elevated and the gastric fundus to be lower than normal. Acute mesenteroaxial gastric volvulus was diagnosed. GI endoscopy showed a distortion of the gastric anatomy with difficulty intubating the pylorus. Various endoscopic maneuvers were required to reposition the stomach, and the symptoms showed immediate and complete solution. GI fluoroscopy was performed 3 days later. Initially, most of the contrast medium accumulated in the fundus, which was drawn prominently downward, and then began flowing into the duodenum with anteflexion. Elective laparoscopic surgery was performed 1 month later. The stomach was in its normal position, but the fundus was folded posteroinferiorly. The spleen attached to the fundus was normal in size but extremely mobile. We diagnosed a wandering spleen based on the operative findings. Gastropexy was performed for the treatment of gastric volvulus and wandering spleen. The patient remained asymptomatic, and there was no evidence of recurrence during a follow-up period of 24 months. This report describes a rare adult case of acute gastric volvulus associated with wandering spleen. Because delay in treatment can result in lethal complications, it is critical to provide a prompt and correct diagnosis and surgical intervention. We advocate laparoscopic surgery after endoscopic reduction because it is a safe and effective procedure with lower invasiveness.
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Affiliation(s)
- Jiro Omata
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan. .,Department of Surgery, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan.
| | - Katsuyuki Utsunomiya
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.,Department of Surgery, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Risa Takahata
- Medical Office, Ministry of Defense, 5-1 Ichigayahonmura, Shinjuku-ku, Tokyo, 162-8801, Japan
| | - Nobuo Miyasaka
- Department of Gastroenterology, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Naoko Sakamoto
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Yoji Yamagishi
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.,Department of Surgery, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan
| | - Makiko Fukumura
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan.,Department of Surgery, KKR Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo, 153-0051, Japan
| | - Daiki Kitagawa
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Mitsuhiko Konno
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Yasushi Okusa
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
| | - Michinori Murayama
- Department of Surgery, Japan Self-Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya-ku, Tokyo, 154-8532, Japan
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11
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Cianci P, Fersini A, Tartaglia N, Altamura A, Lizzi V, Stoppino LP, Macarini L, Ambrosi A, Neri V. Spleen assessment after laparoscopic transperitoneal left adrenalectomy: preliminary results. Surg Endosc 2016; 30:1503-7. [PMID: 26139504 PMCID: PMC4801995 DOI: 10.1007/s00464-015-4363-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/19/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several laparoscopic approaches to the adrenal gland have been described. We prefer the lateral transabdominal approach. The aim of this study is to evaluate prospectively the presence of any anatomical and dynamic changes in the spleen after laparoscopic transperitoneal left adrenalectomy (LTLA), which can cause an increased risk of early and late complications. METHODS We have evaluated 21 patients before and 6 months after surgery in order to verify the possible presence of a wandering spleen. A clinical and instrumental follow-up [ultrasound (US), magnetic resonance (MR)] were performed. During US protocol, in supine, right lateral, and orthostatic position, the longitudinal and anteroposterior diameter of the spleen and the resistive index within 3 cm of the origin of the splenic artery in three different measurements averaged were measured. MR protocol evaluated, in supine and right lateral position, the splenic volume and its distances from the diaphragm dome and the lateral margin of the costal arch. RESULTS p Values calculated for each parameter were not statistically significant. Our results confirm the absence of any anatomical and dynamic changes in the spleen after LTLA. CONCLUSIONS The most common complications after laparoscopic adrenalectomy are well known and widely described. Our experience does not exclude the occurrence of a wandering spleen, but allows us to state that a rightful mobilization of the pancreaticosplenic block can avoid this event, and in agreement with other authors, the presence of a wandering spleen remains an isolated complication.
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Affiliation(s)
- Pasquale Cianci
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy.
| | - Alberto Fersini
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy
| | - Nicola Tartaglia
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy
| | - Amedeo Altamura
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy
| | - Vincenzo Lizzi
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy
| | - Luca Pio Stoppino
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy
| | - Luca Macarini
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy
| | - Antonio Ambrosi
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy
| | - Vincenzo Neri
- Department of Medical and Surgical Sciences, University of Foggia, Luigi Pinto Str 1, 71122, Foggia, Italy
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12
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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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