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Petrucciani N, Barone SC, Mucaj L, D'Angelo F, Aurello P, Silecchia G. Wandering spleen causing small bowel obstruction: Laparoscopic surgical treatment (with video). Int J Surg Case Rep 2023; 112:108961. [PMID: 37839258 PMCID: PMC10667868 DOI: 10.1016/j.ijscr.2023.108961] [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: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Wandering spleen (WS) is a clinical entity in which the spleen is not located in its normal anatomical site. Few cases have been reported, mainly in women of childbearing age. This condition can be congenital or acquired due to excessive elasticity of the spleen's suspensory ligaments. WS may cause acute complications requiring emergency surgery, especially related to the rotation of its vascular pedicle, leading to chronic or acute ischemia. The aim of the present case is to show a rare complication of WS, small bowel obstruction (SBO), and its management. PRESENTATION OF CASE We report the case of a 40-year-old female presenting with abdominal pain, nausea, and vomiting. CT scan showed SBO caused by WS located in the pelvis with an enlarged spleen vascular pedicle (SVP). Laparoscopic exploration, splenectomy, small bowel resection and anastomosis were performed. DISCUSSION WS may cause chronic or acute complications, mainly linked with enlargement and torsion of SVP, including acute ischemia and spleen necrosis, or compression of the near organs such as small intestine, stomach, pancreas. The diagnosis is based on physical examination, CT scan and blood exams. Generally, the WS's treatment is laparoscopic splenectomy or splenopexy. In case of vital spleen, splenopexy can be performed, in case of not vital spleen, splenectomy should be preferred. CONCLUSION This case provides an excellent example of SBO related to WS. In the video, the management of this complex situation is shown. In these cases, splenectomy represents a valuable option.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.
| | - Sara Claudia Barone
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Leonida Mucaj
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco D'Angelo
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Paolo Aurello
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Gianfranco Silecchia
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
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Wang Z, Peng C, Wu D, Wang K, Chen Y. Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction. BMC Pediatr 2022; 22:440. [PMID: 35864485 PMCID: PMC9306085 DOI: 10.1186/s12887-022-03484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction. Methods From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized. Results There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4–170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient. Conclusions Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03484-y.
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Affiliation(s)
- Zengmeng Wang
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Chunhui Peng
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Dongyang Wu
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Kai Wang
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Yajun Chen
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China.
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Imawari K, Uojima H, Hayama K, Toshimitsu F, Sanoyama I, Iwasaki S, Wada N, Kubota K, Hidaka H, Nakazawa T, Shibuya A, Suzuki T, Kumamoto Y, Saegusa M. Splenectomy for Torsion of a Wandering Spleen in a Patient with Myeloproliferative Disease. Intern Med 2022; 61:2143-2148. [PMID: 34897151 PMCID: PMC9381354 DOI: 10.2169/internalmedicine.8391-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We herein report a rare case of torsion of a wandering spleen in a patient with myeloproliferative disease. A 66-year-old Japanese woman presented to our hospital with abdominal pain and a fever. She had a medical history of polycythemia and secondary myelofibrosis. Abdominal enhanced computed tomography showed an enlarged spleen without enhancement in the lower pelvic region. The clinical diagnosis was severe torsion of a wandering spleen in a patient with myeloproliferative disease, necessitating surgical intervention. Splenectomy was performed after de-rotating to revascularize the spleen. After the operation, the platelet count gradually increased, and aspirin was administered to prevent thrombosis.
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Affiliation(s)
- Kana Imawari
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Kei Hayama
- Department of Hematology, Kitasato University School of Medicine, Japan
| | - Fujio Toshimitsu
- Department of Surgery, Kitasato University School of Medicine, Japan
| | - Itaru Sanoyama
- Department of Pathology, Kitasato University School of Medicine, Japan
| | - Shuichiro Iwasaki
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Naohisa Wada
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Kousuke Kubota
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Hisashi Hidaka
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Takahide Nakazawa
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Akitaka Shibuya
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Japan
| | - Takahiro Suzuki
- Department of Hematology, Kitasato University School of Medicine, Japan
| | - Yusuke Kumamoto
- Department of Surgery, Kitasato University School of Medicine, Japan
| | - Makoto Saegusa
- Department of Pathology, Kitasato University School of Medicine, Japan
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Petroianu A. The left gastro-omental vessels are able to maintain the entire spleen blood supply. J Vasc Bras 2022; 21:e20210191. [PMID: 35571522 PMCID: PMC9083538 DOI: 10.1590/1677-5449.20210178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
The spleen is supplied by blood flow through the splenic artery and vein. The purpose of this communication is to report an ectopic spleen supplied only by reverse flow through the left gastro-omental vessels. A 14-year-old boy presented with pelvic splenomegaly supplied only by the left gastro-omental artery and veins connected to the inferior polar vessels, which were the only vessels communicating with the spleen. After detorsion of the spleen and splenopexy, the spleen returned to normal dimensions. The patient had uneventful follow-up. In conclusion, the left gastroepiploic vessels are able to maintain the entire spleen blood supply.
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Labiad C, Vaillant JC, Genser L. Splenic Volvulus and 2q37 Deletion Syndrome. J Gastrointest Surg 2021; 25:2999-3000. [PMID: 33904059 DOI: 10.1007/s11605-021-05013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Camelia Labiad
- Sorbonne Université, Department of Hepato-Biliary and Pancreatic Surgery, Liver transplantation, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Jean-Christophe Vaillant
- Sorbonne Université, Department of Hepato-Biliary and Pancreatic Surgery, Liver transplantation, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Laurent Genser
- Sorbonne Université, Department of Hepato-Biliary and Pancreatic Surgery, Liver transplantation, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, 47-83 boulevard de l'Hôpital, 75013, Paris, France. .,Nutrition and Obesity: Systemic Approach (NutriOmics) Research Unit, Sorbonne Université, INSERM, Paris, France.
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Ioannis G, George P, Athanasios P, Panagiotis V, Theodora P. Torsion of wandering spleen, splenectomy and autotransplantation of splenic slices. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jha AK, Bhagwat S, Dayal VM, Suchismita A. Torsion of spleen and portal hypertension: Pathophysiology and clinical implications. World J Hepatol 2021; 13:774-780. [PMID: 34367498 PMCID: PMC8326160 DOI: 10.4254/wjh.v13.i7.774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
The displacement of spleen from its normal location to other places is known as wandering spleen (WS) and is a rare disease. The repeated torsion of WS is due to the presence of long pedicle and absence/laxity of anchoring ligaments. A WS is an extremely rare cause of left-sided portal hypertension (PHT) and severe gastric variceal bleeding. Left-sided PHT usually occurs as a result of splenic vein occlusion caused by splenic torsion, extrinsic compression of the splenic pedicle by enlarged spleen, and splenic vein thrombosis. There is a paucity of data on WS-related PHT, and these data are mostly in the form of case reports. In this review, we have analyzed the data of 20 reported cases of WS-related PHT. The mechanisms of pathogenesis, clinico-demographic profile, and clinical implications are described in this article. The majority of patients were diagnosed in the second to third decade of life (mean age: 26 years), with a strong female preponderance (M:F = 1:9). Eleven of the 20 WS patients with left-sided PHT presented with abdominal pain and mass. In 6 of the 11 patients, varices were detected incidentally on preoperative imaging studies or discovered intraoperatively. Therefore, pre-operative search for varices is required in patients with splenic torsion.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Sameer Bhagwat
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Vishwa Mohan Dayal
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Arya Suchismita
- Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, Delhi 110070, India
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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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Thomas AK, Thomas R. The likely association between wandering spleen and absent left kidney. Emerg Radiol 2021; 28:431-435. [PMID: 33417114 DOI: 10.1007/s10140-020-01895-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
Wandering spleen is a cause of acute surgical abdomen with serious consequences. It arises from an absence or weakness of the supporting suspensory splenic ligaments. There is often a delayed diagnosis due to its non-specific clinical presentation. This leads to stalled acquisition of confirmatory diagnostic imaging with resultant increased morbidity and mortality. Congenital or acquired absence of the left kidney results in loss of the splenorenal ligament, a key ligament to maintain normal splenic position in the abdomen. Two patients, one with OHVIRA (obstructed hemivagina ipsilateral renal anomaly) syndrome and another who underwent a left nephrectomy during infancy, developed a wandering spleen with acute splenic torsion in the setting of an absent left kidney. This case series aims to increase awareness to the likely predisposition for individuals with an absent left kidney to develop a wandering spleen.
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Affiliation(s)
- Anna Kalathil Thomas
- University of Tennessee Health Science Center, LeBonheur Children's Hospital, 848 Adams Ave. G216, TN, 38103, Memphis, USA.
| | - Rebecca Thomas
- Southern Adventist University, 4881 Taylor Cir, Collegedale, TN, 37315, USA
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Laparoscopic splenectomy for polysplenia with splenic torsion: a case report. Surg Case Rep 2019; 5:28. [PMID: 30778694 PMCID: PMC6379504 DOI: 10.1186/s40792-019-0582-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background Polysplenia refers to the presence of two or more equal-sized spleens. Very rarely, one of the multiple spleens may develop torsion and infarction. Case presentation A 21-year-old woman presented with left upper quadrant pain, the cause of which could not be diagnosed. She returned to our hospital, 2 days later, without any pain improvement. Enhanced computed tomography showed splenic infarction and polysplenia. Initially, we could not identify the cause of the infarction and started conservative therapy, which did not result in any improvement. Hence, we performed a splenectomy, after securing informed consent. Because the patient was a young woman, we opted for a laparoscopic approach. During surgery, we identified the cause of the infarction as spleen pedicle torsion; the infarcted spleen was excised using an automated suturing device. We completed the laparoscopic surgery without converting it to an open laparotomy, and the patient was discharged 4 days later. This was a rare case of polysplenia with splenic torsion. Conclusion Laparoscopic splenectomy is minimally invasive and has cosmetic advantages. Thus, this approach may be considered as a treatment option for this condition.
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