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Subunca R, Sriluxayini M, Priyatharsan K, Mayorathan U, Vinojan S, Heerthikan K. Splenic torsion, a challenging diagnosis in an adult presenting with acute abdomen. Int J Surg Case Rep 2023; 111:108898. [PMID: 37797525 PMCID: PMC10558308 DOI: 10.1016/j.ijscr.2023.108898] [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: 08/26/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Wandering spleen (WS) is a rare condition, occurring in only 0.2 % of cases, where the spleen becomes hypermobile due to the absence or laxity of its anchoring ligaments. Torsion of the spleen, primarily seen in children but occasionally in adults, is a critical complication that can lead to infarction and is considered a medical emergency. CLINICAL PRESENTATION We present a case report of a 50-year-old woman with type 2 diabetes and psychiatric illness presented with 2 days of vomiting, abdominal pain, and dehydration. Physical examination showed a tender mass in the abdomen and imaging confirmed a twisted spleen with a thrombosed splenic vein, leading to a successful emergency splenectomy. The patient had an uncomplicated recovery and was discharged with post-splenectomy protocol. DISCUSSION Splenic torsion, a rare occurrence primarily observed in children. Clinical diagnosis is aided by palpable abdominal masses and confirmed by radiological imaging. The gold standard diagnostic tool is contrast-enhanced computed tomography (CT), whereas Ultrasonography (USG) is equally good in early assessment. Early identification is crucial to salvage the spleen. Management options include detorsion, splenopexy, or splenectomy depending on the organ viability. Elective splenopexy has emerged as a proactive measure, particularly in children, to prevent complications. CONCLUSION Splenic torsion is a rare but important differential diagnosis in patients presenting with acute abdomen. Early diagnosis and prompt management is necessary to preserve the spleen and to prevent the development of complication. Surgery is often necessary and either splenopexy or splenectomy should be done.
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Affiliation(s)
- R Subunca
- Department of Radiology, Teaching Hospital Jaffna, Sri Lanka
| | - M Sriluxayini
- Department of Radiology, Teaching Hospital Jaffna, Sri Lanka
| | - K Priyatharsan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka.
| | - U Mayorathan
- Department of Forensic Pathology, Teaching of Hospital, Sri Lanka
| | - S Vinojan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | - K Heerthikan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
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2
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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: 0] [Impact Index Per Article: 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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3
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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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Bairwa BL, Gupta S, Singh AK. Wandering spleen with torsion: a rare cause of acute abdomen in a 14-year-old girl. Arch Clin Cases 2022; 9:56-61. [PMID: 35813495 PMCID: PMC9262086 DOI: 10.22551/2022.35.0902.10204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Wandering spleen is a rare condition and defined as the spleen that is not in its normal anatomical position due to lack or laxity of suspensory ligaments. Etiological factors are congenital and acquired. Splenic torsion, infraction, and rupture are life-threatening complications of wandering spleen. A 14-year-old girl patient presented to the emergency department with severe pain abdomen for 2 days. On physical examination, a large palpable mass in the mid of the abdomen was found, and CECT confirmed it as torsion of wandering spleen. Emergency exploration is done and splenectomy was done due to non-viability of the spleen. The Post-op period was uneventful. Acute torsion of wandering spleen is an extremely rare clinical entity and patient present in an emergency with clinical features of acute abdomen. They may also present with chronic pain abdomen and abdominal mass. Early diagnosis is vital for the preservation of the spleen. Radiological studies have an important role in an accurate diagnosis. Surgery is the gold standard treatment of wandering spleen. Surgery for splenopexy or splenectomy depends on the condition of the spleen during surgery. Timely diagnosis and interventions are crucial to prevent life-threatening complications of wandering spleen.
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5
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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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Virani P, Farbod A, Niknam S, Akhgari A. Wandering spleen with splenic torsion: Report of two cases. Int J Surg Case Rep 2020; 78:274-277. [PMID: 33373922 PMCID: PMC7776122 DOI: 10.1016/j.ijscr.2020.12.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022] Open
Abstract
Anatomical variation of the spleen’s position in the abdomen, is a rare condition called Wandering Spleen (WS). WS is a vital differential diagnosis in patients presenting with acute abdomen. Concerning the high incidence of splenic torsion in these patients, early recognition is important. We report two cases of this rare condition, prersenting with splenic torsion and abdminal pain.
Introduction and importance Anatomical variation of the spleen’s position in the abdomen, is a rare condition called Wandering Spleen (WS). WS is a vital differential diagnosis in patients presenting with acute abdomen and diagnosis should be made promptly to prevent development of serious complications. Case presentation In this article, we report two cases of WS (27 and 20 years old females) presenting with abdominal pain due to splenic torsion. Both Patients underwent splenectomy and discharged with no further complications. Clinical discussion The presentation of a wandering spleen varies from an asymptomatic mass to an acute abdomen due to torsion and splenic infarction, therefore recognition of this condition can be challenging. Diagnosis depends on imaging studies, and treatment options consist of performing either splenectomy or splenopexy. Conclusion Concerning the high incidence of splenic torsion and infarction in WS patients, early recognition of this condition and initiation of apt intervention is of great significance.
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Affiliation(s)
- Peyman Virani
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Farbod
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saman Niknam
- Department of Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aisan Akhgari
- Medical Student, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
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7
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Skiba R, Ghosh DN, Barker A. Torsion of a Wandering Spleen Managed Conservatively: Rare and Interesting. J Indian Assoc Pediatr Surg 2020; 25:323-325. [PMID: 33343117 PMCID: PMC7732016 DOI: 10.4103/jiaps.jiaps_216_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/14/2020] [Accepted: 04/01/2020] [Indexed: 11/04/2022] Open
Abstract
Wandering spleen is a rare pathology. A 2-year-old child with abdominal pain was diagnosed to have a torted, avascular wandering spleen. On conservative management, she remains well with no radiological evidence of the spleen. Splenic torsion usually warrants surgery. Nonoperative management in selected cases allows the natural process of autosplenectomy.
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Affiliation(s)
- Rohen Skiba
- Department of Surgery, Princess Margaret Hospital for Children/Perth Children's Hospital, Perth, Australia
| | - Dhruva Nath Ghosh
- Department of Surgery, Princess Margaret Hospital for Children/Perth Children's Hospital, Perth, Australia
| | - Andrew Barker
- Department of Surgery, Princess Margaret Hospital for Children/Perth Children's Hospital, Perth, Australia
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8
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Manoharan D, Kumar A, Krishna A, Bansal VK. Unusual pseudocyst in a wandering spleen. BMJ Case Rep 2019; 12:12/9/e229948. [PMID: 31492728 DOI: 10.1136/bcr-2019-229948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudocysts of the spleen are rare, generally asymptomatic lesions developing secondary to trauma, infection or infarction. When symptomatic, they typically present as non-specific pain in the left hypochondrium, with or without a palpable lump on clinical examination. However, these conventions fail when they occur in a wandering spleen, making imaging critically important. This report describes an unusual case of a 50-year-old who presented with a large cystic mass in a pelvic spleen; imaging facilitated a successful splenectomy and subsequent histopathology revealed a pseudocyst in a wandering spleen.
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Affiliation(s)
- Dinesh Manoharan
- Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Atin Kumar
- Radiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Asuri Krishna
- General Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
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9
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Anne Ng MR, Mccullers M, Gamenthaler A. Wandering Spleen with 720-degree Torsion Treated with Splenectomy and Distal Pancreatectomy. Am Surg 2019. [DOI: 10.1177/000313481908500825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Awan M, Gallego JL, Al Hamadi A, Vinod VC. Torsion of wandering spleen treated by laparoscopic splenopexy: A case report. Int J Surg Case Rep 2019; 62:58-61. [PMID: 31445501 PMCID: PMC6717052 DOI: 10.1016/j.ijscr.2019.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 01/06/2023] Open
Abstract
Wandering spleen. Laparoscopic splenopexy. Torsion of splenic pedicle.
Introduction A wandering spleen is a mobile spleen as a result of deficient splenic peritoneal ligaments and elongation of its vascular pedicle. It is a rare entity affecting mainly young adults commonly females and children, presenting as an asymptomatic abdominal mass or abdominal discomfort due to torsion and de-torsion of the pedicle. Presentation of case We report a 35-year-old female presented with intermittent colicky abdominal pain that worsened in severity over three weeks. Diagnostic laparoscopy showed torsion of spleen without infarction. Detorsion and Splenopexy in an extra-peritoneal pouch was performed. Post operatively, the patient recovered well and was healthy at two months follow up. Discussion A wandering spleen is either congenital or acquired. The condition results in a long vascular pedicle, which predispose to the torsion resulting in a partial or complete infarct of the spleen. Laparoscopic approach is the preferred technique and de-torsion of the splenic pedicle and splenopexy is a reasonable surgical option, when there is no evidence of infarction of the spleen. Conclusion The diagnosis of wandering spleen is very rare and extremely difficult to establish and is clinically nonspecific. An early diagnosis and surgical care are required for preserving the spleen. Additional imaging examinations can help establish a diagnosis.
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Affiliation(s)
- Mariyem Awan
- Department of Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | - Jose Luis Gallego
- Department of Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | - Annett Al Hamadi
- Department of Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
| | - Vijay Chander Vinod
- Department of Accident & Emergency, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates.
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11
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Abstract
Wandering spleen is a rare entity that results from the absence or maldevelopment of the ligaments that support the spleen in its normal location. As a result, the spleen is hypermobile and may be predisposed to hilar torsion and subsequent infarction, making it a potentially fatal abdominal emergency. We present a case of a 36-year-old Afghan female who presented with an acute abdomen, and was radiologically and surgically confirmed to have a wandering spleen with torsion and complete infarction. Knowledge of this condition and its radiological findings can play a crucial role in making a correct and timely diagnosis.
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Affiliation(s)
- Dawar B Khan
- Department of Radiology, The Aga Khan University, Karachi, PAK
| | | | | | - Sarim D Khan
- Medical College, The Aga Khan University, Karachi, PAK
| | - Rabail Raza
- Department of Radiology, The Aga Khan University, Karachi, PAK
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12
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Anand S, Yadav DK, Sharma S, Varshney A. Acute torsion of a wandering spleen: a paediatric emergency. BMJ Case Rep 2018; 2018:bcr-2018-225496. [PMID: 29950372 DOI: 10.1136/bcr-2018-225496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sachit Anand
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shilpa Sharma
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Abhimanyu Varshney
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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13
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Wandering spleen with horseshoe kidney a rare occurrence. Int J Surg Case Rep 2018; 45:96-100. [PMID: 29602063 PMCID: PMC6000907 DOI: 10.1016/j.ijscr.2018.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 01/05/2023] Open
Abstract
Wandering spleen with horseshoe kidney is a rare occurrence with less than 3 cases reported worldwide. Delay in diagnosis would result is increased mortality. Splenopexy is preferred in children with the exception of grossly infarcted spleen. Splenectomy is the treatment of choice in torsion of spleen with infarct.
Introduction Wandering spleen is a rare clinical entity in itself, with only 2 cases reported thus far when correlated with congenital under-development of the kidney, it usually happens due to under development of its surrounding ligaments. Herein we present a case of wandering spleen with underlying congenital deformity of horseshoe kidney which requires splenectomy due to late presentation. Presentation of case A 21 year old lady presented with worsening of chronic abdominal pain for 3 years, associated with nausea and vomiting. Physical examination showed a vague mass located at epigastric region. Consecutively, computed tomography images showed a well-defined, oval, hypoechoic spleen extending from center of abdomen up to epigastric region measuring 15.5 × 13 cm with twisted pedicle. Finally the patient underwent surgical treatment. The intraoperative findings were consistent with computed tomography images. The patient made a full recovery and was discharged well. Discussion Wandering Spleen was first described by Van Horne during autopsy back in 1667. Its location is maintained by peritoneal attachments such as lienorenal, splenocolic, splenophrenic, gastrosplenic and phrenicocolic ligaments. Among which, the gastrosplenic ligament and lienorenal ligaments are of greatest significance. Patient with a wandering spleen may present asymptomatic, with a movable mass in the abdomen, or with chronic or intermittent abdominal pain because of partial torsion and spontaneous de-torsion of the spleen as in our case. When feasible especially in young patients, splenopexy should always be the first consideration but however if gross infarct has occurred then splenectomy is inevitable to save the patient. Conclusion Wandering spleen is a unique surgical entity moreover when appeared in congruence with horseshoe kidney. Its diagnosis should be made in prompt to prevent splenic infarction and to try to salvage with splenopexy especially in younger population. However in patient where splenic torsion with infarction has occurred, splenectomy would be the treatment of choice.
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14
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Viana C, Cristino H, Veiga C, Leão P. Splenic torsion, a challenging diagnosis: Case report and review of literature. Int J Surg Case Rep 2018; 44:212-216. [PMID: 29529542 PMCID: PMC5928290 DOI: 10.1016/j.ijscr.2018.02.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/07/2018] [Accepted: 02/22/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Wandering spleen is an unusual condition characterized by hypermobility of the spleen. This is a rare clinical entity and it's more common in childhood under 1 year of age and in third decade of life. In this second peak, it's more frequent in females. Clinical manifestations can vary from asymptomatic to abdominal emergency. Treatment is often surgical. PRESENTATION OF CASE We presented a case report of splenic torsion from our hospital and a review of cases described in literature. This is a 40 year-old woman with complaints of upper abdominal pain associated with nausea and vomiting. A marked tenderness and a palpable abdominal mass on left hypochondrium were found as well as a slight increase in inflammatory parameters. A CT was performed and demonstrated findings compatible with splenic torsion. Surgery was performed doing laparoscopic splenectomy; Review of literature was made using the keyword combination: "wandering spleen". The research resulted in 451 articles. DISCUSSION The physical examination and CT are fundamental for diagnosis. Surgery was performed and laparoscopic splenectomy was made because infarcted spleen; about the review of literature, the majority of patients were female and the average age at the time of diagnosis was 25.2 years. 69.5% needed splenectomy and 78.6% of surgeries were laparotomic. CONCLUSION Splenic torsion is a rare but important differential diagnosis in patients presenting with acute abdomen. Diagnosis should be made promptly before development of life-threatening complications. Surgery is often necessary and splenopexy or splenectomy can be done.
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Affiliation(s)
- C Viana
- Department of General Surgery, de Braga Hospital, Braga, Portugal.
| | - H Cristino
- Department of General Surgery, de Braga Hospital, Braga, Portugal
| | - C Veiga
- Department of General Surgery, de Braga Hospital, Braga, Portugal
| | - P Leão
- Department of General Surgery, de Braga Hospital, Braga, Portugal; Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, de Gualtar Campus, 4709-057 Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal
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15
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Reisner DC, Burgan CM. Wandering Spleen: An Overview. Curr Probl Diagn Radiol 2017; 47:68-70. [PMID: 28385371 DOI: 10.1067/j.cpradiol.2017.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/13/2017] [Indexed: 12/22/2022]
Abstract
An ectopic (or "wandering") spleen results from abnormal ligamentous laxity failing to fixate the spleen in its normal location in the left upper quadrant. Ligamentous laxity can be acquired due to conditions, such as splenomegaly or pregnancy, but is often congenital. Because of this laxity, there is an elongated vascular pedicle, which is prone to torsion and resultant splenic infarction. These patients generally present with abdominal pain and other nonspecific symptoms making the diagnosis very difficult to make clinically. As such, the radiologist plays a crucial role in the diagnosis and care of these patients, as often the diagnosis is only considered after imaging.
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Affiliation(s)
- David C Reisner
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.
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16
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Ricci ZJ, Oh SK, Stein MW, Kaul B, Flusberg M, Chernyak V, Rozenblit AM, Mazzariol FS. Solid organ abdominal ischemia, part I: clinical features, etiology, imaging findings, and management. Clin Imaging 2016; 40:720-31. [DOI: 10.1016/j.clinimag.2016.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/26/2016] [Accepted: 02/17/2016] [Indexed: 02/08/2023]
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17
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Hussain FB, Ambusaidi F. Torsion of wandering spleen. Int J Pediatr Adolesc Med 2016; 3:43-45. [PMID: 30805467 PMCID: PMC6372406 DOI: 10.1016/j.ijpam.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 12/18/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Faisal Bin Hussain
- MBC 28, P.O. Box 3354, King Faisal Specialist Hospital and Research Centre, Riyadh, 11211, Saudi Arabia
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18
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Rajaram B, Venkanna M, Kumar DR, Kumaraswamy B, Reddy BS. Ectopic Spleen Presenting as Lump Abdomen: A Rare Case Report and Review of Literature. J Clin Diagn Res 2015; 9:PD26-7. [PMID: 26500956 DOI: 10.7860/jcdr/2015/13135.6541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022]
Abstract
Ectopic spleen is due to failure of fusion of the mesogastrium and the lining body wall epithelium, resulting in lax or absent supporting ligaments of spleen, making it abnormally mobile. This case presented as lump abdomen with history of recurrent attacks of abdominal pain. Clinical diagnosis was unidentified abdominal mass. The radiological imaging was suggestive of the diagnosis, and the exploration of abdomen has clinched the diagnosis.
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Affiliation(s)
- Bapurapu Rajaram
- Associate Professor, Department of General Surgery, Kakatiya Medical College/ Mahatma Gandhi Memorial Hospital , Warangal, Telangana, India
| | - Madipeddi Venkanna
- Assistant Professor, Department of General Surgery, Kakatiya Medical College/ Mahatma Gandhi Memorial Hospital , Warangal, Telangana, India
| | - Dodda Ramesh Kumar
- Professor, Department of General Surgery, Kakatiya Medical College/ Mahatma Gandhi Memorial Hospital , Warangal, Telangana, India
| | - Boda Kumaraswamy
- Assistant Professor, Department of General Surgery, Kakatiya Medical College/ Mahatma Gandhi Memorial Hospital , Warangal, Telangana, India
| | - Bachannagari Srinivas Reddy
- Junior Resident, Department of General Surgery, Kakatiya Medical College/ Mahatma Gandhi Memorial Hospital , Warangal, Telangana, India
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19
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FARIDI MS, KUMAR A, INAM L, SHAHID R. Wandering Spleen- A diagnostic Challenge: Case Report and Review of Literature. Malays J Med Sci 2014; 21:57-60. [PMID: 25897284 PMCID: PMC4391456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 12/17/2014] [Indexed: 06/04/2023] Open
Abstract
Wandering spleen or hypermobile spleen results from the elongation or maldevelopment of the spleen's suspensory ligaments. It is a rare clinical entity that mainly affects children. Among adults, it is most commonly found in females of active reproductive age. It may present as an asymptomatic mass in the abdomen, or it may present with intermittent abdominal discomfort because of torsion and spontaneous detorsion of the spleen. We present the case of a 37-year-old female who had features of intestinal obstruction with mass per abdomen. Exploratory laparotomy showed an infarcted spleen. A total splenectomy was performed.
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Affiliation(s)
- Mohammad Shazib FARIDI
- Department of Surgery, University College
of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi 110095, India
| | - Ashish KUMAR
- Department of Surgery, University College
of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi 110095, India
| | - Lubna INAM
- Department of Obstetrics and Gynaecology,
Era’s Lucknow Medical College and Hospital, Lucknow, 226 003, Uttar Pradesh,
India
| | - Razi SHAHID
- Era’s Lucknow Medical College and Hospital,
Lucknow, 226 003, Uttar Pradesh, India
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20
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McBrearty A, McGuinness E, Neill A. Wandering spleen: a potential abdominal catastrophe. Clin Case Rep 2014; 1:42-3. [PMID: 25356206 PMCID: PMC4184540 DOI: 10.1002/ccr3.9] [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: 05/22/2013] [Revised: 07/17/2013] [Accepted: 07/28/2013] [Indexed: 11/11/2022] Open
Abstract
Key Clinical Message We describe the case of a wandering spleen complicated by volvulus and demonstrate the role of radiology and urgent intervention in managing this rare but potentially fatal condition.
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Affiliation(s)
- Anthony McBrearty
- General Surgery, Daisy Hill Hospital 5 Hospital Road, Newry, BT35 8DR, U.K
| | - Etain McGuinness
- General Surgery, Daisy Hill Hospital 5 Hospital Road, Newry, BT35 8DR, U.K
| | - Adrian Neill
- General Surgery, Daisy Hill Hospital 5 Hospital Road, Newry, BT35 8DR, U.K
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21
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Ihedioha U, Syed A, Lloyd G, Scott A. Conservative treatment of splenic infarction and intestinal obstruction caused by a wandering spleen. Scott Med J 2014; 59:e18-20. [PMID: 24700108 DOI: 10.1177/0036933014530847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The underdevelopment or absence of the splenic suspensary ligaments can lead to an uncommon condition termed the wandering spleen. It is usually asymptomatic but can present with an acute abdomen when associated with torsion. Most authors advocate surgical treatment. Herein, we report a case of torsion with infarction of the spleen and intestinal obstruction in a 36-year-old female patient which was successfully managed conservatively.
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Affiliation(s)
- U Ihedioha
- Specialist Registrar in General Surgery, Department of Surgery, University Hospitals of Leicester NHS Trust, UK
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22
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Bouzaidi K, Daghfous A, Ben Ali M, Karma S, Rezgui Marhoul L. [Infarction of a wandering spleen - a case report]. Presse Med 2013; 43:225-8. [PMID: 24184280 DOI: 10.1016/j.lpm.2013.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/11/2013] [Accepted: 04/30/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Khaled Bouzaidi
- Hôpital MT Maâmouri, service d'imagerie médicale, 8000 Nabeul, Tunisie
| | - Alifa Daghfous
- Centre des grands brulés, service d'imagerie médicale, 2013 Ben Arous, Tunisie.
| | - Mechaal Ben Ali
- Hôpital MT Maâmouri, service d'anesthésie réanimation, 8000 Nabeul, Tunisie
| | - Sahbi Karma
- Hôpital MT Maâmouri, service d'imagerie médicale, 8000 Nabeul, Tunisie
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23
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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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Jones B, Callahan J, Cole A, Hawking N, Diment D, Browning P. The Case of the Wandering Spleen. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2012. [DOI: 10.1177/8756479312472392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Wandering spleen is a condition that describes the movement of the spleen to an ectopic location inside the abdomen/pelvis as a result of weakened peritoneal ligaments. Wandering spleens are rare, with a less than 0.2% incidence being reported. Diagnosing a wandering spleen can be challenging because of the wide range of findings and the oftentimes vagueness of the patient’s symptoms. The most common ectopic location of the spleen is the left mid-abdomen. The most frequent treatment for wandering spleen includes splenopexy or splenectomy, depending on the complications associated with the condition.
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Affiliation(s)
| | | | - Alisa Cole
- University of Arkansas, Fort Smith, AR, USA
| | | | - David Diment
- St Edward Mercy Medical Center, Fort Smith, AR, USA
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Bouassida M, Sassi S, Chtourou MF, Bennani N, Baccari S, Chebbi F, Benali M, Mighri MM, Touinsi H, Sassi S. A wandering spleen presenting as a hypogastric mass: case report. Pan Afr Med J 2012; 11:31. [PMID: 22514765 PMCID: PMC3325069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 02/14/2012] [Indexed: 11/02/2022] Open
Abstract
Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all of the ligaments that hold the spleen in its normal position in the left upper quadrant of the abdomen. It is an uncommon clinical entity that mainly affects children. Among adults it most frequently affects women of reproductive age, in whom acquired laxity of the splenic ligaments is usually the cause. Patients with a wandering spleen may be asymptomatic, present with a movable mass in the abdomen, or have chronic or intermittent abdominal pain because of partial torsion and spontaneous detorsion of the spleen. A 26-year-old woman was admitted to our hospital with vomiting and abdominal pain. Abdominal examination revealed a large ovoid hypogastric mass. A CT scan showed a wandering spleen in the hypogastric region. Exploratory laparotomy revealed an ischemic spleen. A total splenectomy was performed.
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Affiliation(s)
- Mahdi Bouassida
- Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
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