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Hanifa H, Al-Shami K, Al-Shaher T, Ataya J, Al-Abrass M, Moezzen H, Ghannam T. Gastric volvulus with necrosis and gangrene associated with wandering spleen: A rare case report from Syria. SAGE Open Med Case Rep 2024; 12:2050313X241262141. [PMID: 38881967 PMCID: PMC11179459 DOI: 10.1177/2050313x241262141] [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: 02/14/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Gastric volvulus and wandering spleen are two rare and uncommon conditions. Gastric volvulus is characterized by the rotation of the stomach around itself, causing a closed obstruction. It was first described in the 19th century and is classified according to the axis, etiology, or chronicity. A wandering spleen is defined by the absence of one or all of the splenic ligaments, which occurs either for congenital or acquired reasons. An enlarged spleen may contribute to the wandering spleen and, in turn, lead to gastric volvulus and infarction of the stomach, requiring emergency surgical intervention. In this report, we present a case of a 19-year-old female who presented to the emergency department with severe abdominal pain and epigastric distension. After performing the necessary investigations, she was diagnosed with a wandering spleen and acute gastric volvulus. An immediate laparotomy was performed and both the spleen and the stomach were resected to save the patient's life at the right time.
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Affiliation(s)
- Hamdah Hanifa
- Faculty of Medicine, University of Kalamoon, Al-Nabk, Syria
- Al-Dandashi National Group, Yaafour, Damascus, Syria
| | - Khayry Al-Shami
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | | | - Jamal Ataya
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Mohammad Al-Abrass
- Faculty of Medicine, University of Kalamoon, Al-Nabk, Syria
- Department of Urology, Al-Kalamoon Hospital, Al-Nabk, Syria
| | - Hanan Moezzen
- Department of General Surgery, Al-Kalamoon Hospital, Al-Nabk, Syria
| | - Tarik Ghannam
- Department of General Surgery, Al-Kalamoon Hospital, Al-Nabk, Syria
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Rasheed O, Wassouf A, Abo Al Shamat A, Daoud R, Knaj D, Ahmad G. Wandering spleen in a postpartum female: a case report. Ann Med Surg (Lond) 2024; 86:3099-3102. [PMID: 38694347 PMCID: PMC11060191 DOI: 10.1097/ms9.0000000000001960] [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: 11/01/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction and importance Wandering spleen (WS) is a rare condition that occurs when the spleen is not in its normal anatomical location, but in the abdominal or pelvic cavity. The mechanism of this condition may be due to dysfunction of ligaments that fixate the spleen in its position. Female hormonal alterations during pregnancy and other unknown causes in children may also play role in an ectopic spleen. Case presentation The authors report a case of a 34-year-old woman who presented to the emergency department with intermittent abdominal pain that persisted after childbirth without other symptoms. Clinical discussion Clinically the symptoms are varied and abdominal pain is the most common presentation. Radiological investigation of WS include ultrasound, MRI, and CT, which is the most preferred tool. Treatments after the diagnosis include splenectomy or splenopexy either through laparoscopy or laparotomy. Conclusion Physicians should include ectopic spleen as a differential diagnosis in a multiparous woman with the presentation of acute or chronic abdominal pain.
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Affiliation(s)
| | | | - Aiman Abo Al Shamat
- Faculty of Medicine, Al Andalus University for Medical Sciences, Qadmus, Tartus, Syrian Arab Republic
| | | | - Duaa Knaj
- PhD student, Faculty of Medicine, Tishreen University, Lattakia
| | - Ghanem Ahmad
- Professor of Vascular Surgery, Tishreen University, Faculty of Medicine
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Eleiwi M, Atatri Y, Younis O, Zuhd J, Awadghanem A, Qashoo A, Sholi S, Bustame S. Wandering Spleen Torsion: A Diagnostic Challenge. Cureus 2024; 16:e53552. [PMID: 38445142 PMCID: PMC10913703 DOI: 10.7759/cureus.53552] [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: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
Wandering spleen, or hypermobile spleen, arises from the elongation or maldevelopment of the spleen's suspensory ligaments. This condition is a rare clinical entity, primarily affecting children, with a higher prevalence among adult females in the active reproductive age group. Manifestations may include an asymptomatic abdominal mass or intermittent abdominal discomfort due to the torsion and subsequent spontaneous detorsion of the spleen. This case report details the presentation of a 14-year-old female initially misdiagnosed as having gastroenteritis who later experienced acute abdomen. Subsequent ultrasonography and computed tomography scan revealed splenic torsion, confirmed during exploratory laparotomy, which demonstrated an infarcted spleen. The definitive therapeutic intervention was a total splenectomy. This clinical entity should be taken into account in the differential diagnosis of acute abdominal pain in order to aid in early diagnosis and management. This could allow us to avoid splenectomy whenever possible and instead do splenopexy, especially in pediatric cases, as the spleen plays a crucial role in the reticuloendothelial system.
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Affiliation(s)
- Malak Eleiwi
- Medicine, An-Najah National University Hospital, Nablus, PSE
| | - Yazid Atatri
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Omar Younis
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Jehad Zuhd
- Anesthesia, An-Najah National University Hospital, Nablus, PSE
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Ahmed Awadghanem
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Ahmad Qashoo
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Suha Sholi
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Samer Bustame
- Pediatric Surgery, An-Najah National University Hospital, Nablus, PSE
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
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Khan H, Fatima K, Aman M, Khan F, Khan P, Safi MI. Wandering spleen with acute torsion mimicking an adnexal mass. Radiol Case Rep 2023; 18:4094-4098. [PMID: 37727144 PMCID: PMC10505588 DOI: 10.1016/j.radcr.2023.08.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/12/2023] [Indexed: 09/21/2023] Open
Abstract
Wandering spleen manifests when the splenic ligaments are underdeveloped, or become lax, thereby allowing the spleen to relocate from its anatomical site to more distant areas. During such movements, torsion of the long splenic peduncle is common, which can lead to symptoms of acute abdomen and further complications such as infarction. It is typically seen in children and young females. Our report presents a case of a 22-year-old female presenting to the ER with complaints of severe pain in the abdominal region. On ultrasound, there was suspicion of an adnexal mass, which was later confirmed to be a misplaced spleen in the lower abdomen, with torsion, fat stranding, and splenic vein thrombosis, as revealed by enhanced CT abdomen and pelvic MRI. It was followed by an emergency splenectomy. As wandering spleen presents nonspecifically and is a rare condition, it is important to consider wandering spleen when patients present similarly to this case, to prevent misdiagnosis and to deliver surgical treatment quickly to preserve the spleen.
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Affiliation(s)
- Hana Khan
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Kulsoom Fatima
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Aman
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Faheemullah Khan
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Poonum Khan
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Ismail Safi
- Department of Radiology, Nishtar National Kidney Hospital, Jalalabad, Afghanistan
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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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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Moore E, O’Brien JW, Merali N, Farkas N, Madhavan A, Abbassi-Ghadi N, Preston S, Singh P. Gastric outlet obstruction secondary to a wandering spleen: systematic review and surgical management of a case. Ann R Coll Surg Engl 2023; 105:501-506. [PMID: 36688842 PMCID: PMC10313450 DOI: 10.1308/rcsann.2022.0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION A wandering spleen occurs when laxity or absence of the suspensory ligaments allows migration throughout the abdomen. Gastric outlet obstruction resulting from this abnormality is rare. We present a systematic literature search and a case that was managed successfully with surgical intervention at our centre. METHODS A systematic search of the PubMed, Embase™, Medline® and Google Scholar™ databases was carried out employing the combined search terms "gastric outlet obstruction" AND "wandering spleen". Six results were included for final analysis. RESULTS All six search results described a single case each. Patients underwent surgical management (open or laparoscopic) after initial investigation utilising a range of modalities. There were no mortalities reported at 90 days. The single case we present was complicated by gastric perforation; the patient made a successful recovery following open splenopexy and stapled wedge resection of the stomach. CONCLUSIONS A wandering spleen is a rare diagnosis and there are only six reported cases of gastric outlet obstruction secondary to a wandering spleen in the literature. None report associated gastric perforation. There are a variety of presenting symptoms, intraoperative findings and operative techniques used to address the gastrosplenic abnormality. The case reported by our centre adds to this limited evidence base and demonstrates a successful outcome from definitive surgical management. We highlight the need to seek early gastro-oesophageal expertise if any gastric pathology is found together with anatomical abnormality of the spleen.
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Affiliation(s)
- E Moore
- Royal Surrey NHS Foundation Trust, UK
| | | | | | | | | | | | - S Preston
- Royal Surrey NHS Foundation Trust, UK
| | - P Singh
- Royal Surrey NHS Foundation Trust, UK
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Infantino I, Tocchioni F, Ghionzoli M, Coletta R, Morini F, Morabito A. Case Report: Gut and spleen anomalies associated with DYRK1A syndrome. Front Pediatr 2023; 10:936732. [PMID: 36741085 PMCID: PMC9890171 DOI: 10.3389/fped.2022.936732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
DYRK1A syndrome has been extensively studied primarily with regard to neurologic and other phenotypic features such as skeleton and craniofacial alterations. In the present paper, we aim to highlight unusual anomalies associated with a DYRK1A mutation: a 17-year-old female patient with language and cognitive delay, microcephaly, and an autistic disorder, who was operated upon for spleen torsion with anomalous gut fixation.
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Affiliation(s)
- I. Infantino
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - F. Tocchioni
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
| | - M. Ghionzoli
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
| | - R. Coletta
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
- School of Health and Society, University of Salford, Salford, United Kingdom
| | - F. Morini
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
| | - A. Morabito
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- Department of Pediatric and Neonatal Surgery, Meyer Children's Hospital IRCSS, Florence, Italy
- School of Health and Society, University of Salford, Salford, United Kingdom
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9
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Wandering, twisted spleen in a deerhound. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Maienza E, Chereau N, Menegaux F. Surgical Management of a Volvulus of a Wandering Spleen Associated with a Volvulus of the Small Intestine. Case Rep Surg 2022; 2022:8696492. [PMID: 35492869 PMCID: PMC9054486 DOI: 10.1155/2022/8696492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction A wandering spleen is a rare anatomical condition characterized by a free-floating splenic tissue that is not located in its normal position in the left upper quadrant. This condition is usually asymptomatic but can also manifest itself with volvulus of the spleen and consequent infarction and necrosis of the parenchyma, requiring an urgent surgical management. Additionally, a wandering spleen can be associated with other contemporaneous anatomical anomalies. Case Presentation. We report a case of a 21-year-old woman, admitted to our hospital for intense abdominal pain and vomiting. A CT scan revealed a wandering spleen in the mesogastric area with the spleen torted on its axis, associated with a volvulus of the small intestine. Abdominal exploration revealed a macroscopically normal free-floating spleen attached to an abnormally long vascular pedicle. The management of the wandering spleen was conservative, and a splenopexy was performed. Conclusions The torsion of the wandering spleen constitutes an infrequent but life-threatening abdominal emergency. The diagnosis of the wandering spleen is frequently challenging since clinical findings are usually not specific. Imaging such as computed tomography scan plays an important role in the differential diagnosis pathway. Treatment should be planned according to the splenic parenchyma conditions. Splenectomy is indicated when massive infarction and thrombosis of splenic vessels have occurred. When splenic parenchyma is not compromised, it is preferred to perform a conservative surgical technique, such as splenopexy, in order to avoid postsplenectomy complications.
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Affiliation(s)
- Elisa Maienza
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris, France
| | - Nathalie Chereau
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris, France
| | - Fabrice Menegaux
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, Paris, France
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Sun C, Li SL. Successful treatment of floating splenic volvulus: Two case reports and a literature review. World J Clin Cases 2021; 9:8812-8819. [PMID: 34734060 PMCID: PMC8546827 DOI: 10.12998/wjcc.v9.i29.8812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The floating spleen refers to the spleen moving away from the normal anatomical position to other parts of the abdominal cavity.
CASE SUMMARY In this report, we describe two cases of torsion of floating spleen, which were successfully treated by laparoscopic partial splenectomy and retroperitoneal fixation of the residual spleen. The clinical characteristics of previously reported cases are also discussed.
CONCLUSION In conclusion, laparoscopic partial resection of splenic volvulus infarction and extraperitoneal fixation of residual spleen are safe and reliable.
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Affiliation(s)
- Chi Sun
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Suo-Lin Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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