1
|
Ahmed S, Iqbal S, Batool S, Khan R. Splenic torsion mistaken for an ovarian cyst: a case report. J Med Case Rep 2024; 18:181. [PMID: 38615066 PMCID: PMC11016203 DOI: 10.1186/s13256-024-04502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/10/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed. CASE PRESENTATION A 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days. CONCLUSION Splenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.
Collapse
Affiliation(s)
- Salaar Ahmed
- Medical College, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
| | - Shahid Iqbal
- Medical College, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Shariqa Batool
- Medical College, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Rizwan Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
2
|
Schrijver WAME, Dijkstra RF, van der Werff YD. [Acute abdomen based on a wandering spleen]. Ned Tijdschr Geneeskd 2021; 165:D5318. [PMID: 34346582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND A wandering spleen is a relatively unknown condition, where the spleen may be enlarged and is located in an aberrant position in the abdomen. It is caused by abnormally constructed or absent ligaments that should keep the spleen in the correct position or an excessively long vascular stem. The pathophysiology is congenital or secondary to trauma, abdominal surgery, pregnancy or splenomegaly. CASE DESCRIPTION A 21-year-old woman was presented at the emergency department with acute abdominal pain in the left lower quadrant. A CT-scan of the abdomen showed splenomegaly, with the spleen showing reduced blood flow and a location in the lower abdomen. During an emergency laparoscopy, the spleen was found to be ischemic based on a torsion of the vascular pedicle. A splenectomy followed and the patient showed an uncomplicated recovery. CONCLUSION Splenopexy or splenectomy is the treatment of choice for a symptomatic wandering spleen.
Collapse
|
3
|
Abstract
Wandering spleen is a rare condition in which the spleen is hypermobile due to laxity or lack of its supporting ligaments. It can be located anywhere in the abdomen besides its usual position. The other terms that are used to describe this condition are splenic ptosis, displaced spleen, dislocated spleen and ectopic spleen. Splenic torsion is a dreaded complication and the usual cause of symptoms. There is a high chance of missing the diagnosis as it remains asymptomatic or may be incidentally discovered on radio-imaging done for a different purpose. An acute abdomen is the most common presentation. Here we describe an unusual case presenting with torsion of the wandering spleen that was adherent to the right ovary.
Collapse
Affiliation(s)
- Malvika Gulati
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Abhishek Suman
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
4
|
Lim PPC, Dasgupta K, Wheeler T. Wandering Spleen in a 1-Year-Old Girl: An Enigmatic Journey to Find the Hiding Necrotic Spleen. S D Med 2019; 72:459-463. [PMID: 31816207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Wandering spleen, otherwise known as ectopic spleen, is a rare congenital or acquired condition, especially in pediatric patients, characterized by elongated splenic pedicle due to congenital or acquired laxity of suspensory splenic ligaments resulting in exaggerated splenic mobility that predisposes it to torsion and often to subsequent infarction. We present a case of a 1-year old Caucasian female who presented with acute abdomen showing infarcted ectopic spleen on imaging. Most patients with infarcted spleen require surgery as the standard intervention. However, our patient was managed medically and had an excellent outcome in the absence of surgery.
Collapse
Affiliation(s)
- Peter Paul C Lim
- Department of Pediatrics, Avera Queen of Peace Hospital, Mitchell, South Dakota
- Rainbow Babies Children's Hospital
| | - Kingshuk Dasgupta
- Avera McKennan Children's Hospital and University Health Center, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Tamara Wheeler
- Avera Queen of Peace Hospital, Department of Radiology, Mitchell, South Dakota
| |
Collapse
|
5
|
Hurtig J, Gkekas I, Näsvall P. [Torsion of wandering spleen - unusual cause to acute abdominal pain in pediatric patients]. Lakartidningen 2018; 115:FA9Z. [PMID: 30457661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Wandering spleen is a rare reason for acute abdominal pain in pediatric patients caused by laxity of the splenic ligaments. It can be complicated by torsion of the pedicle, leading to ischemia, a situation that in most cases results in acute abdominal surgery. To prevent ischemia of a mobile spleen caused by a total occlusion of the pedicle, splenopexy can be considered. We present an unusual case where changes in the position of the operating table during diagnostic laparoscopy might have caused a total occlusion of the pedicle.
Collapse
Affiliation(s)
- Jennie Hurtig
- Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus - Allmänkirurgi Lulea, Sweden
| | - Ioannis Gkekas
- Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus - Allmänkirurgi Lulea, Sweden
| | - Pia Näsvall
- Sunderby sjukhus - Allmänkirurgi Luleå, Sweden Sunderby sjukhus, Allmänkirurgi - Lulea, Sweden
| |
Collapse
|
6
|
Vaynshtein J, Guetta O, Replyansky I, Vakhrushev A, Czeiger D, Ovnat A, Sebbag G. Wandering Spleen: Three Subsequent Cases in Young Women. Isr Med Assoc J 2018; 20:656-657. [PMID: 30324789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Julie Vaynshtein
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ohad Guetta
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilya Replyansky
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alexander Vakhrushev
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David Czeiger
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amnon Ovnat
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
7
|
Spears SM, White RS, McConkey MJ. What Is Your Diagnosis? J Am Vet Med Assoc 2018; 252:1463-1466. [PMID: 29889641 DOI: 10.2460/javma.252.12.1463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
8
|
Cohen O, Baazov A, Samuk I, Schwarz M, Kravarusic D, Freud E. Emergencies in the Treatment of Wandering Spleen. Isr Med Assoc J 2018; 20:354-357. [PMID: 29911755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Wandering spleen is a rare entity that may pose a surgical emergency following torsion of the splenic vessels, mainly because of a delayed diagnosis. Complications after surgery for wandering spleen may necessitate emergency treatment. OBJECTIVES To describe the clinical course and treatment for children who underwent emergency surgeries for wandering spleen at a tertiary pediatric medical center over a 21 year period and to indicate the pitfalls in diagnosis and treatment as reflected by our experience and in the literature. METHODS The database of a tertiary pediatric medical center was searched retrospectively for all children who underwent emergency treatment for wandering spleen between 1996 and 2017. Data were collected from the medical files. The relevant literature was reviewed. RESULTS Of ten patients who underwent surgery for wandering spleen during the study period, five underwent seven emergency surgeries. One patient underwent surgery immediately at initial presentation. In the other four, surgical treatment was delayed either due to misdiagnosis or for repeated imaging studies to confirm the diagnosis. Emergency laparotomy revealed an ischemic spleen in all patients; splenectomy was performed in two and the spleen was preserved in three. Four of the seven emergency operations were performed as the primary surgery and three were performed to treat complications. CONCLUSIONS Wandering spleen should ideally be treated on an elective or semi-elective basis. Surgical delays could be partially minimized by a high index of suspicion at diagnosis and by eliminating unnecessary and time-consuming repeated imaging studies.
Collapse
Affiliation(s)
- Osher Cohen
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur Baazov
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Samuk
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Schwarz
- Department of Pediatric Radiology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dragan Kravarusic
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Enrique Freud
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
9
|
Demirel A, Hansen MA, Sunesen KG, Nerstrøm P. [Wandering spleen in a patient hospitalized with acute abdomen]. Ugeskr Laeger 2017; 179:V01170025. [PMID: 28648152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
An 11-year-old girl was hospitalized with a two-day history of lower abdominal pain. The patient had a localized peritoneal reaction in the right lower quadrant, an elevated C-reactive protein level, and an increased white blood cell count. On the suspicion of acute appendicitis a diagnostic laparoscopy was performed. This revealed a misplaced spleen in the right side of the pelvis with a partly torsion of a long vascular pedicle. The splenic tissue was vital without any sign of ischaemia. However, splenopexy was not possible, and an uncomplicated elective splenectomy was performed.
Collapse
|
10
|
Bacha S, Habibech S, Attia M, Cheikhrouhou S, Chaouch N, Racil H, Chabbou A. [Pulmonary opacity]. Rev Med Interne 2017; 39:441-442. [PMID: 28277264 DOI: 10.1016/j.revmed.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/21/2016] [Indexed: 11/17/2022]
Affiliation(s)
- S Bacha
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie.
| | - S Habibech
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - M Attia
- Service de radiologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - S Cheikhrouhou
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - N Chaouch
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - H Racil
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| | - A Chabbou
- Service de pneumologie, hôpital Abderrahmane-Mami, 2080 Ariana, Tunisie
| |
Collapse
|
11
|
Mattioni L, Peña ME, Ringa M, Schlottmann F, Bugari G. [Wandering spleen: an unusual cause of acute abdomen]. Medicina (B Aires) 2017; 77:43-45. [PMID: 28140311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Wandering spleen syndrome is a rare condition in which absence or laxity of splenic fixing elements predisposes to an unusual location in the abdomen and an increasing risk of twisting and infarction. Its etiology may be congenital or acquired and clinical presentation is variable. Diagnosis is based on clinical suspicion, laboratory and imaging. Surgery is the only definitive treatment for this pathology. We report the case of a 23 year old woman with a history of recurrent episodes of abdominal pain in the left upper quadrant since childhood. On physical examination she was afebrile, hemodynamically stable, with marked abdominal tenderness in the left upper quadrant. Ultrasonography showed homogeneous splenomegaly. Abdominal CT-scan presented an enlarged, eutopic spleen, with swirling and congestion of hilum vessels. Splenic ischemia due to organ torsion was suspected. Exploratory laparoscopy was performed showing an 18 cm in diameter spleen free in left upper quadrant, with varicose veins in the periphery and without fixing ligaments. Laparoscopic splenectomy was completed. The pathology report showed ischemic necrosis of the organ. The patient progressed favorably and was discharged on the third postoperative day.
Collapse
Affiliation(s)
- Laura Mattioni
- Servicio de Cirugía General, Departamento de Cirugía, Hospital Alemán de Buenos Aires, Argentina
| | - María Elena Peña
- Servicio de Cirugía General, Departamento de Cirugía, Hospital Alemán de Buenos Aires, Argentina
| | - Maximiliano Ringa
- Servicio de Cirugía General, Departamento de Cirugía, Hospital Alemán de Buenos Aires, Argentina
| | - Francisco Schlottmann
- Servicio de Cirugía General, Departamento de Cirugía, Hospital Alemán de Buenos Aires, Argentina. E-mail:
| | - Gustavo Bugari
- Servicio de Cirugía General, Departamento de Cirugía, Hospital Alemán de Buenos Aires, Argentina
| |
Collapse
|
12
|
Ahmadi H, Tehrani MMK. A Rare Case of Splenic Torsion with Sigmoid Volvulus in a 14-Year-Old Girl. Acta Med Iran 2016; 54:72-75. [PMID: 26853294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Wandering spleen is an uncommon entity in adults and has been described only rarely with sigmoid volvulus, that rarely affects children and adolescents. It is usually described in adults.Wandering spleen characterized by the abnormal location of the spleen, caused by incomplete fusion of the four primary splenic ligaments, allowing the spleen to be mobile within the abdomen.The wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important. We present a rare clinical case of acute abdomen due to torsion of wandering spleen and volvulus of sigmoid in a 14-year-old girl presented with painful periumbilical mass. Detorsion of sigmoid occurred while undergoing exploratory laparotomy and splenectomy was performed. The possibility of torsion and its complication like gastric, pancreas tail and colon volvulus should be kept in mind in the differential diagnosis of the acute abdomen to avoid serious complications.
Collapse
Affiliation(s)
- Hamid Ahmadi
- Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
13
|
Esayas R. SPLENIC TORTION IN A WANDERING SPLEEN: A CASE REPORT FROM AYDER REFERRAL HOSPITAL. Ethiop Med J 2015; 53:109-111. [PMID: 26591299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 46 years old female patient presented with worsening of abdominal pain of 12 days duration & abdominal swelling of 15 years. On examination, she had an elliptical, mildly tender mass on the periumblical area extending to the right flank & the suprapubic area. It is mobile & firm in consistency. The intra op finding was huge spleen weighing 2 kgs, rotated 360 degrees clockwise, situated over the right side of the abdomen. This case report showed that a wandering spleen can present acutely with tortion mimicking acute abdomen.
Collapse
|
14
|
Tandilava RZ, Bakhtadze TI, Koridze LT, Tandilava ZR. [Twisting of migrating spleens in a child aging 14 years]. Klin Khir 2015:79-80. [PMID: 26072553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
15
|
Abstract
Wandering spleen is a rare but potentially clinically significant entity, and may be a cause for a patient presenting with acute abdomen. Because wandering spleen may present with non-specific symptoms and presentation, it can be a difficult diagnosis to make clinically. This paper describes a case report of the use of dynamic Magnetic Resonance Imaging (MRI) in a young woman to confirm the diagnosis of wandering spleen pre-operatively. The patient underwent a splenopexy and a post-operative MRI confirmed the successful surgical fixation of the patient's spleen.
Collapse
Affiliation(s)
- James K Clark
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
| | - John Gorman
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Mike H Lee
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Brian C Barbick
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Robert M Marks
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
| |
Collapse
|
16
|
Abstract
Wandering spleen is a rare clinical entity characterized by splenic hypermobility resulting from laxity or maldevelopment of the suspensory splenic ligaments. The spleen can "wander" or migrate into various positions within the abdomen or pelvis due to this ligamentous laxity. It is usually detected between 20 and 40 years of age, and is more common in women. The clinical presentation of a wandering spleen is variable, it could present as an asymptomatic, incidentally detected, abdominal or pelvic mass, or as an acute abdomen secondary to splenic torsion. Diagnosis in an emergent setting can be challenging as it is a rare cause of acute abdomen and does not produce any symptoms until splenic torsion has occurred. We present and discuss a case of ectopic, torsed spleen resulting in complete infarction of the spleen and severe hepatic vascular compromise, diagnosed by ultrasound, confirmed by computed tomography and effectively managed by splenectomy.
Collapse
|
17
|
Kaabar N, Ben Abdallah R, Yengui H, Hellal Y, Ben Malek R, Bouthour H, Sayed S. Torsion of a wandering spleen: a case report. Tunis Med 2014; 92:275-277. [PMID: 25224425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Wandering spleen is a rare entity in child. It is generated by laxity or failure of development of spleen ligaments causing the migration of the spleen from its normal anatomical site to another abdominal or pelvic location. It can be congenital or acquired. The most dangerous complication is the occurrence of torsion of the spleen around its pedicle. aim: Report of a new observation and present the diagnostic, treatment and outcome aspects of torsion of ectopic spleen. CASE We report the case of a 17 years old girl who was admitted for an acute abdomen pain and fever. Clinical examination revealed generalized abdominal defence and an under umbilical mass which was very painful on palpation. Ultrasound and CT scans have visualized the pelvic mass, which measured four inches long axis. The spleen wasn't on its normal seat. The patient was operated urgently. Surgical exploration showed that the mass corresponded to a wandering spleen in pelvic position, necrotic and twisted around its pedicle. A splenectomy was performed with simple sequences. CONCLUSION torsion of the wandering spleen can progress to total necrosis of the spleen mass. This complication is feared in any ectopic and painful spleen.
Collapse
|
18
|
Olasehinde O, Aderibigbe AS, Akinkuolie AA, Adisa AO, Ajenifuja KO, Aladesuru OA, Oyekunle O. Torsion of wandering spleen, an unusual cause of acute abdomen; a report of two cases. Afr J Med Med Sci 2014; 43:75-78. [PMID: 25335381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Wandering spleen is an uncommon entity that is rarely considered in the evaluation of patients with acute abdominal conditions. OBJECTIVE To report two cases of wandering spleen presenting with acute abdominal pain. METHODS The clinical records of the patients including preoperative evaluation, intra-operative findings and postoperative care were reviewed RESULT A 6 year old boy presented with right lumbar pain which worsened over a 36 hour period with findings of a tender right lumbar mass. Abdominal ultrasound showed a mass with echogenicity consistent with that of the spleen with no blood flow and an empty splenic bed. The pre-operative diagnosis was torsion of a wandering spleen. The second case was that of a 42 year old woman who presented with severe colicky lower abdominal pain which worsened over three days with a background history of progressively increasing lower abdominal mass which was tender and about 26 week gestational size at presentation. The initial diagnosis was torsion of an ovarian cyst. Abdomino-pelvic Ultrasound scan showed a heterogeneously hypo-echoic mass overlying the uterus and the left ovary with no blood flow. The presence of wandering spleen with torsion of the vascular pedicle was confirmed at laparotomy in both instances. Splenectomy was performed in both cases with good recovery. CONCLUSION Torsion of a wandering spleen poses a diagnostic challenge. A high level of suspicion is required to make a diagnosis and institute appropriate treatment.
Collapse
|
19
|
Heydari MB, Johari HG, Eskandari S. Wandering spleen presenting as small bowel obstruction. Am J Emerg Med 2013; 31:984-5. [PMID: 23680329 DOI: 10.1016/j.ajem.2013.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 02/10/2013] [Indexed: 12/30/2022] Open
|
20
|
Helvind NM, Gögenur I, Stadeager M. [Splenic torsion as cause of acute abdomen in children]. Ugeskr Laeger 2013; 175:587-588. [PMID: 23608013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A six-year-old boy was admitted with symptoms consistent with acute appendicitis. Immediately before placement of the first trocar, a large abdominal mass was observed which on imaging was identified as a torsioned spleen. Due to suboptimal reperfusion and risk of reperfusion-mediated morbidity a splenectomy was performed. The recovery was uneventful. The child had a twin brother who on a routine ultrasound examination was found to have a normally positioned spleen. Challenges in diagnosis and treatment of children with splenic torsion is discussed.
Collapse
Affiliation(s)
- Neel Maria Helvind
- Center for Perioperativ Optimering, Gastroenheden, Herlev Hospital, Denmark.
| | | | | |
Collapse
|
21
|
Sudák M, Drahovský P. [Torsion of dystopic spleen--possible solutions]. Rozhl Chir 2011; 90:701-704. [PMID: 22509658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Early diagnosis the torsion of wandering spleen and surgical intervention are necessary to preserve the spleen, because persistant torsion can lead to splenic infarction. We present two cases with torsion of wandering spleen and different disease process and result. Diagnosis was by ultrasonography and CT angiography found. The 7-year-old boy with recurrent abdominal pain was admitted early and operated with spleenpreserving splenopexy. The 8-year-old girl with acute torsion of a wandering spleen was sent of after an initial misdiagnosis too late. Patient was managed by urgent laparotomy and splenectomy, because of splenic vessels thrombosis and splenic infarction. No complications occurred during two year postoperative follow up period of both patients.
Collapse
Affiliation(s)
- M Sudák
- 1 Oddelenie detskej chirurgie DFN Kosice, Slovenská republika.
| | | |
Collapse
|
22
|
Affiliation(s)
- Ashutosh M Somalwar
- Department of Internal Medicine, Government Medical College and Hospital, Nagpur, India.
| | | | | |
Collapse
|
23
|
Salem JF, Tannouri F, Salem F. [A case of wandering spleen: a rare cause of acute abdomen]. J Med Liban 2011; 59:170-172. [PMID: 22259909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present the case of a 17-year-old patient known to have an asymptomatic ectopic spleen, who presented with an acute abdomen. Clinical symptoms and ultrasound led to suspect an acute appendicitis, confirmed later on by pathology. Twenty-four hours after the appendectomy, the patient complained of an abdominal pain of acute onset. Torsion of the pedicle of the ectopic spleen was suspected. Imaging studies supported this diagnosis, and an urgent splenectomy was performed. Did the torsion happen by simple coincidence 24 hours after appendectomy, knowing that the spleen has been asymptomatic for 17 years, or was it precipitated by the surgical intervention? Should we have removed the ectopic spleen during the appendectomy? This is the first report of a case of torsion of a wandering spleen after a laparotomy; a review of the literature is done in order to explain the physiopathology of the disease, and to propose its management.
Collapse
Affiliation(s)
- Jean F Salem
- Division of General Surgery, American University of Beirut Medical Center, Lebanon.
| | | | | |
Collapse
|
24
|
Familua O, Animesh R, Quinto E, Barzideh S, Eboh N, Morales L, Rodriguez L. Wandering spleen mimicking acute appendicitis-an unusual presentation of a rare surgical anomaly. Am Surg 2010; 76:E235-E236. [PMID: 21352678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
25
|
Ghazeeri G, Nassar AH, Taher AT, Musallam KM, Jamali FR. The wanderer At 12 weeks' gestation, the patient presented with abdominal pain and a palpable mass. Am J Obstet Gynecol 2010; 202:662.e1. [PMID: 20362957 DOI: 10.1016/j.ajog.2010.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 11/10/2009] [Accepted: 02/02/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Ghina Ghazeeri
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | | | | |
Collapse
|
26
|
Affiliation(s)
- Chang-An Tseng
- Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan
| | | |
Collapse
|
27
|
Biondi A, Motta S, Di Giunta M, Rapisarda D, Fichera DS, La Greca C, Ciuni R, Basile F. [Pelvic splenomegaly. Ptosic, migrant or accessory spleen?]. Ann Ital Chir 2009; 80:395-397. [PMID: 20131554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A wandering or ectopic spleen is a rare condition in which the spleen is not located in the left upper quadrant but is found lower in the abdomen or in the pelvic region caused by improper fixation of the ligamentous attachments. Laxity of the peritoneal attachments of the spleen results in splenic hyper mobility, known as wandering spleen. Congenital and acquired causes have been advocated to explain its onset. However, the precise aetiology is not completely understood. Many patients with wandering spleen are asymptomatic and therefore, the real incidence is unknown. Symptomatic patients may have intermittent abdominal pain because of splenic congestion with intermittent torsion of the splenic pedicle and its spontaneous detorsion, or may present acutely with pedicle torsion with subsequent infarction. Pain and dangerous potential evolution recommend surgery, splenoplexy or splenectomy. The Authors report the case of a 48-year-old man with painful abdominal mass suspected for wandering splenomegaly after diagnostic imaging (abdominal Ultrasonography and TC). Laparotomy evidenced a large spleen (DL 22 cm.) with a long (1 mt) and tortuous vascular pedicle, both removed. Histopathologic examination showed partial infarction of the spleen. The postoperative course was uneventful.
Collapse
Affiliation(s)
- Antonio Biondi
- Azienda Ospedaliera Universitaria Vittorio Emanuele-Ferrarotto- S. Bambino Catania
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Wandering spleen is a rare condition that can lead to splenic infarction or rupture if torsion persists. Early diagnosis and intervention are necessary, and abdominal ultrasonography and abdominal computed tomography are well accepted as the diagnostic imaging modalities. In this study, we present a boy with nic infarction due to acute torsion of a wandering spleen, after initial failure to demonstrate an ectopic spleen. Instead, acute torsion of the wandering spleen with spontaneous partial detorsion was incidentally found by multi-detector row CT with angiography. The patient was managed by splenectomy instead of splenopexy, because poor reperfusion after Laparoscopic detorsion.
Collapse
Affiliation(s)
- Chi-Hone Lien
- Department of Pediatrics, Mackay Memorial Hospital, Hsin Chu Branch, Taiwan
| | | | | | | | | |
Collapse
|
29
|
Di Crosta I, Inserra A, Gil CP, Pisani M, Ponticelli A. Abdominal pain and wandering spleen in young children: the importance of an early diagnosis. J Pediatr Surg 2009; 44:1446-9. [PMID: 19573677 DOI: 10.1016/j.jpedsurg.2009.02.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 01/27/2009] [Accepted: 02/28/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the study is to increase clinical awareness of torsion of wandering spleen (WS) in childhood and the need of a rapid diagnosis. METHODS Four cases operated for torsion of WS are retrospectively reviewed. Ages at presentation were, respectively, 30 months, 5 years, 4 years, and 3 years, without sex preference. All subjects led a history of abdominal pain and a mass on physical examination. RESULTS Torsion of WS should be suspected in any child presenting with acute abdomen. Moreover, in case of acute abdomen and intermittent abdominal pain, we suggest studying spleen position with ultrasound. CONCLUSIONS Ultrasonography with color Doppler is the best choice for diagnosis of torsion of WS. Computed tomography is a good complementary examination, but it needs to submit young patients to a general anesthesia and delays an emergency situation.
Collapse
Affiliation(s)
- Ida Di Crosta
- Department of Pediatric Surgery, University Hospital Joan XXIII, 43007, Tarragona, Spain.
| | | | | | | | | |
Collapse
|
30
|
Dirican A, Burak I, Ara C, Unal B, Ozgor D, Meydanli MM. Torsion of wandering spleen. BRATISL MED J 2009; 110:723-725. [PMID: 20120444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Wandering spleen is characterized by ectopic localization of spleen owing to the lack or weakening of the major splenic ligaments. In present study, two cases with torsion of wandering spleen were reported. The first case was a 30-year-old female who was admitted to emergency department with acute abdominal pain and vomiting. Abdominal Ultrasonography and computed tomography showed a round solid hypodense mass that was located in the left hypochondriac region of abdomen. At laparotomy, the patient was found to have torsion of a wandering spleen with complete infarction and pancreatic tail infarction. Splenectomy and distal pancreatectomy were performed. The second patient was a 19-year-old female. She was admitted to emergency department with abdominal pain. Axial computed tomography (CT) showed pelvic mass that indicated a possibility of a wandering spleen. The wandering spleen was removed with its long pedicle because of infarction. Torsion of wandering spleen must be considered in differential diagnosis of acute abdomen when a palpable painful abdominal mass is present on physical examination, and the spleen is absent in its normal anatomical location on radiological examination (Fig. 4, Ref. 8). Full Text (Free, PDF) www.bmj.sk.
Collapse
Affiliation(s)
- A Dirican
- Inonu University, Faculty of Medicine, Department of General Surgery, Malatya, Turkey.
| | | | | | | | | | | |
Collapse
|
31
|
Wani S, Abdulkarim AB, Buckles D. Gastric variceal hemorrhage secondary to torsion of wandering spleen. Clin Gastroenterol Hepatol 2008; 6:A24. [PMID: 19081521 DOI: 10.1016/j.cgh.2008.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 05/16/2008] [Accepted: 06/08/2008] [Indexed: 02/07/2023]
Affiliation(s)
- Sachin Wani
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | |
Collapse
|
32
|
Singla V, Galwa RP, Khandelwal N, Poornachandra KS, Dutta U, Kochhar R. Wandering spleen presenting as bleeding gastric varices. Am J Emerg Med 2008; 26:637.e1-4. [PMID: 18534317 DOI: 10.1016/j.ajem.2007.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2007] [Accepted: 10/24/2007] [Indexed: 12/18/2022] Open
Abstract
Ectopic spleen (splenoptosis) is an extremely rare condition in which the spleen is present in a nonanatomical position. Patients' symptomatology is variable and ranges from mere feeling of an abdominal lump to sudden abdominal pain due to infarction. Patient may have subacute to chronic abdominal or gastrointestinal complaints. Because of nonspecific symptoms, clinical diagnosis can be difficult; hence, imaging plays an important role. Presentation as a case of portal hypertension is extremely rare. We report a case of splenic torsion in a middle-aged woman who presented with hemetemesis from gastric varices secondary to chronic volvulus of an ectopic spleen. Preoperative diagnosis was made on the basis of ultrasonography, endoscopy, and computed tomography, which was later proved on surgery and treated successfully.
Collapse
Affiliation(s)
- V Singla
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | | | | | | | | | | |
Collapse
|
33
|
Affiliation(s)
- Huai-Tzu Michael Liu
- Department of Radiology, Monash Medical Center, Rm. 116, 246 Clayton Rd., Clayton South, Victoria 3168, Australia.
| | | |
Collapse
|
34
|
Safioleas MC, Stamatakos MC, Diab AI, Safioleas PM. Wandering spleen with torsion of the pedicle. Saudi Med J 2007; 28:135-6. [PMID: 17206307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Wandering spleen is a rare medical entity. It usually occurs at 20-40 years of age, and most cases are seen in women. Clinical diagnosis is difficult due to lack of symptoms, unless splenic torsion has occurred and clinical symptomatology of acute abdomen develops. The diagnosis can be confirmed by imaging techniques. Treatment is operative due to complications of splenic infarction. Splenopexy is the usual treatment, except for cases of splenic infarction. Splenectomy should be carried out when there is no evidence of splenic blood flow after detorsion of the spleen and in cases of excessive splenomegaly.
Collapse
Affiliation(s)
- Michael C Safioleas
- 2nd Department of Propedeutic Surgery, Medical School, Athens University, Athens, Greece.
| | | | | | | |
Collapse
|
35
|
Takayasu H, Ishimaru Y, Tahara K, Otani Y, Yamagishi J, Ikeda H. Splenic autotransplantation for a congested and enlarged wandering spleen with torsion: report of a case. Surg Today 2006; 36:1094-7. [PMID: 17123138 DOI: 10.1007/s00595-006-3303-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 05/16/2006] [Indexed: 10/23/2022]
Abstract
In children with diseases of the spleen, every effort should be made to preserve the organ, to prevent severe infections postsplenectomy. We report the case of a 7-year-old girl with torsion of a wandering spleen who we treated by autotransplantation of splenic tissues following splenectomy, when fixation of the enlarged spleen seemed impossible. Spleen scintigraphy showed uptake in the regenerating splenic tissues 9 months after surgery, and evidence of an increase in the size of the tissues 23 months after surgery. Howell-Jolly bodies had disappeared by 16 months after surgery. These findings suggested that the transplanted splenic tissues were resuming splenic functions. Based on our experience with this case, we conclude that autotransplantation after splenectomy is a treatment option for wandering spleen with torsion when fixation seems difficult because of splenic congestion and enlargement.
Collapse
Affiliation(s)
- Hajime Takayasu
- Department of Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
Wandering spleen is an uncommon clinical entity accounting for less than 0.5% of all splenectomies performed. It can be an incidental finding in asymptomatic patients or it can be found in patients with acute or chronic clinical presentation due to compression (urinary retention, constipation), alterations in splenic function (thrombocytopenia or hypersplenism), or torsion of a vascular pedicle. Wandering spleen is diagnosed by imaging techniques, usually ultrasound, CT, or MRI. scintigraphy or arteriography can also be useful in cases with inconclusive findings. Although cases of wandering spleen associated to diverse masses (epidermoid cysts, simple cysts, cystic lymphangiomas, and lymphomas) have been reported in the literature, to our knowledge there are no reports of this entity associated to inflammatory pseudotumor. We present the case of a patient with wandering spleen associated to inflammatory pseudotumor.
Collapse
|
37
|
Barisić-Skok B, Dobec Meić B, Cvetko D, Milevcić-Kurtović Z. [Diagnostic methods in torsion of the spleen]. Acta Med Croatica 2006; 60:273-6. [PMID: 16933842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Torsion of a spleen is a frequent complication of a rare entity--a wandering spleen. A wandering spleen is revealed occasionally, with physical and/or sonographic exam. However, it is often overseen. It has very unspecific simptoms, and can present a diagnostic problem. Splenic torsion manifets itself like an acute abdomen. We have presented a rare case of splenic torsion with unusual clinical findings, followed by a splenic infarction. Due to their promptness, sensitivity, uniqueness and availability, two diagnostic methods have definitive primacy in visualisation of splenic torsion: Color-Doppler sonography and CT with intravenous application of contrast medium.
Collapse
|
38
|
Mazariegos I, Montésino L, Beaune S, Paulet R, Coudray JK, Thyrault M. Anguishing over a spleen. Am Surg 2006; 72:560-1. [PMID: 16808215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
|
39
|
Abstract
Wandering spleen is a rare entity, in which the spleen is abnormally mobile due to its attachment by a long vascular pedicle. This long vascular pedicle predisposes it to various complications, the most common being torsion. Here, we present a case in which a wandering spleen in a young female was complicated by pseudocyst formation, and discuss the possible aetiology, pathogenesis, diagnosis and therapeutic implications of this extremely rare complication.
Collapse
Affiliation(s)
- K Taori
- Department of Radiology, Government Medical College, Nagpur, PIN 440003, India
| | | | | | | |
Collapse
|
40
|
Sharon N, Schachter J, Talnir R, First J, Rubinstein U, Bilik R. Weird activity and the wandering spleen. Isr Med Assoc J 2005; 7:744-5. [PMID: 16309003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Nehama Sharon
- Department of Pediatric Hemato-Oncology, Sanz Medical Center, Laniado Hospital, Netanya, Israel.
| | | | | | | | | | | |
Collapse
|
41
|
Lin CH, Wu SF, Lin WC, Chen AC. Wandering spleen with torsion and gastric volvulus. J Formos Med Assoc 2005; 104:755-8. [PMID: 16385380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Wandering spleen, defined as a spleen without its usual peritoneal attachments, is a rare entity, particularly in children. It usually occurs in those aged 20 to 40 years, and most cases occur in women. Patients usually become symptomatic when torsion of the splenic pedicle occurs. Gastric volvulus, like wandering spleen, is also related to anomalies of intraperitoneal visceral attachments. However, cases of wandering spleen associated with gastric volvulus are rare. We report a case of wandering spleen with torsion and gastric volvulus. The patient was a 4-year-old girl who presented with acute intractable vomiting and abdominal pain. Exploratory laparotomy was performed under the impression of wandering spleen with torsion. The gastric volvulus was found intraoperatively. Following splenectomy and gastropexy, Haemophilus influenza type b and pneumococcus vaccination and prophylactic antibiotics were given. She recovered uneventfully and had no signs of illness or ongoing infection at 1-year follow-up after the operation.
Collapse
Affiliation(s)
- Chien-Heng Lin
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | | | | | | |
Collapse
|
42
|
Schaarschmidt K, Lempe M, Kolberg-Schwerdt A, Schlesinger F, Hayek I, Jaeschke U. The technique of laparoscopic retroperitoneal splenopexy for symptomatic wandering spleen in childhood. J Pediatr Surg 2005; 40:575-7. [PMID: 15793739 DOI: 10.1016/j.jpedsurg.2004.11.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Wandering spleen is an uncommon diagnosis, difficult to prove by standard investigations. The authors report a new method for laparoscopic splenopexy in children using a balloon-dilated retroperitoneal pouch. METHODS From 3 accesses, the spleen is mobilized and displaced into a retroperitoneal pouch dilated to the double splenic volume. The pouch is dilated by a self-made balloon via a further intercostal access and narrowed by sutures incorporating the cranial and caudal edge of the gastrosplenic ligament. RESULTS The peritoneal pouch contracts around the retroperitoneal spleen resulting in a firm fixation of the organ. This technique was successful in a 9-year-old girl with a 5-year history of severe recurrent abdominal pain. CONCLUSIONS Laparoscopic retroperitoneal pouch splenopexy is a safe and effective procedure for symptomatic wandering spleen precluding the use of foreign materials in this age group.
Collapse
Affiliation(s)
- Klaus Schaarschmidt
- Helios-Center for Pediatric Surgery, Klinikum Buch, D-13125 Berlin, Germany.
| | | | | | | | | | | |
Collapse
|