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Belayneh ES, Belete AW, Mitku A, Ahmed HM, Yirdaw H, Ketema T. Gastric volvulus and splenopancreatic torsion with wandering spleen: A case report. Int J Surg Case Rep 2024; 116:109338. [PMID: 38308980 PMCID: PMC10847792 DOI: 10.1016/j.ijscr.2024.109338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastric volvulus is an uncommon potentially life-threatening medical condition characterized by rotation of the stomach or part of the stomach around its longitudinal or transverse axis. Acute gastric volvulus usually presents with the triads of epigastric pain, nonproductive retching, and inability to pass the nasogastric tube. Diagnosis is assisted with abdominal and chest x-ray and contrast studies. CASE PRESENTATION A 53-year-old female presented with abdominal pain of two days duration which started at the epigastric region and later on became diffuse all over the abdomen. She had associated frequent episodes of vomiting which were initially bilious followed by nonproductive retching and low-grade intermittent fever. Abdominal examination showed a distended, diffusely tender abdomen with an ill-defined epigastric mass. Abdominal X-ray showed central abdominal circular opacity continuous with stomach outline. Intraoperative findings revealed perforated gangrenous mesenteroaxial gastric volvulus and splenopancreatic torsion with wandering spleen. Proximal subtotal gastrectomy with esophagogastric anastomosis and splenopexy was performed. The patient was discharged on the 10th postoperative day and had an uneventful post-operative recovery. CLINICAL DISCUSSION Primary gastric volvulus is usually mesenteroaxial with the pylorus commonly rotating anteriorly. Primary gastric volvulus can be associated with congenital asplenia and wandering spleen as both conditions are characterized by absent or loose ligamentous attachments. This case was a mesenteroaxial volvulus with splenopancreatic torsion with a wandering spleen caused by abnormal ligamentous attachments. CONCLUSION A high index of suspicion for early diagnosis of gastric volvulus and timely intervention is required to improve treatment outcome.
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Affiliation(s)
| | | | - Alemneh Mitku
- St. Paul's Hospital Millennium Medical College, Department of Surgery, Ethiopia
| | - Halid Melkamu Ahmed
- St. Paul's Hospital Millennium Medical College, Department of Surgery, Ethiopia
| | - Hilmneh Yirdaw
- St. Paul's Hospital Millennium Medical College, Department of Surgery, Ethiopia
| | - Tsion Ketema
- St. Paul's Hospital Millennium Medical College, Department of Surgery, Ethiopia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Liao W, Huang H, Zhao X, Jiang H. A new surgical approach for a child with acute torsion of the wandering spleen: A case report. Asian J Surg 2023; 46:1174-1175. [PMID: 35999102 DOI: 10.1016/j.asjsur.2022.08.031] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/06/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Wenge Liao
- Department of Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
| | - Hong Huang
- Department of Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xing Zhao
- Department of Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongfei Jiang
- Department of Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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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. [PMID: 36688842 DOI: 10.1308/rcsann.2022.0149] [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] [Journal Information] [Subscribe] [Scholar Register] [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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Bough GM, Gargan KE, Cleeve SJ, Farrell S. Diagnosis, management and outcome of splenic torsion; a systematic review of published studies. Surgeon 2021; 20:e296-e305. [PMID: 34666939 DOI: 10.1016/j.surge.2021.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/17/2021] [Accepted: 08/22/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Splenic torsion is a rare condition but one that many surgeons will encounter once in their career. Management options are varied but due to the rarity of the condition there are no contemporary evidence-based summaries to inform a treating clinician. We aim to describe patterns of presentation and provide an evidence-based guide to the management. METHODS A PRISMA structured meta-analysis was conducted of all published cases of splenic torsion and a recent case added from our institution. RESULTS 408 cases were identified between 1888 and 2021 and a single case added from our institution, 312 cases were sourced from case reports and 96 from 40 case series. 8% of patients had a co-existing congenital anomaly and 28% an identified risk factor for splenic torsion. 82% required emergency surgery. A preoperative diagnosis is becoming more common, reaching 80% in 2020's. While spleen conserving surgery is feasible using a variety of techniques. splenectomy was the definitive management for the majority (82%). On histopatholy no occult disease was identified and a significant number of resected spleens were potentially viable; 32% were reported to be normal or congested and 14% demonstrated only partial or focal necrosis. DISCUSSION Despite the significant publication bias implied by the methodology this is a large dataset in a rare condition. Splenic torsion frequently occurs in a premorbid population. The presence of a palpable mass in the context of abdominal pain should increase suspicion and trigger cross sectional imaging. Conservation of the spleen, using the techniques discussed, should be seriously considered.
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Affiliation(s)
- Georgina M Bough
- Department of Paediatric Surgery, The Royal London Hospital, London, UK; Department of Paediatric Surgery, Addenbrookes Hospital, Cambridge, UK.
| | | | - Stewart J Cleeve
- Department of Paediatric Surgery, The Royal London Hospital, London, UK
| | - Stephen Farrell
- Department of Paediatric Surgery, Addenbrookes Hospital, Cambridge, UK
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Abstract
INTRODUCTION AND IMPORTANCE A wandering spleen is characterized by excessive splenic mobility due to the laxity of its ligaments, which leads to spleen migration and its long mobile vascular pedicle is liable to torsion. The purpose of this paper was to present a wandering splenomegaly reduction after splenic detorsion and splenopexy. CASE PRESENTATION A 14-year-old boy presented a symptomatic visible pelvic wandering splenomegaly with torsion of the splenic pedicle. He was submitted to laparotomy, detorsion of the spleen, and splenopexy to the left diaphragm and surrounded peritoneum. The patient had an uneventful follow-up and was discharged from the hospital on the second postoperative day. All laboratory exams went to normal. The size of the spleen reduced from the 22 × 16 × 13 cm before the treatment to 14 × 12 × 10 cm after the surgical procedure. CLINICAL DISCUSSION The most relevant aspect of this communication is the reduction of the huge splenomegaly to a normal size spleen after detorsion of the splenic vessels and splenopexy to the left diaphragm. Reduction of the splenic size is well-known after distal splenorenal shunt, but this is the first publication of a spontaneous splenic size reduction after treating a congestive wandering splenomegaly by detorsion of the spleen pedicle. CONCLUSION Ectopic congestive splenomegaly due to the splenic pedicle rotation is adequately treated by splenic detorsion and splenopexy in its proper subdiaphragmatic site, which reduces the splenic size to normal.
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Affiliation(s)
- Andy Petroianu
- Corresponding author at: Avenida Afonso Pena, 1626 – apto. 1901, Belo Horizonte, MG 30130-005, Brazil.
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Abstract
Wandering spleen is a cause of acute surgical abdomen with serious consequences. It arises from an absence or weakness of the supporting suspensory splenic ligaments. There is often a delayed diagnosis due to its non-specific clinical presentation. This leads to stalled acquisition of confirmatory diagnostic imaging with resultant increased morbidity and mortality. Congenital or acquired absence of the left kidney results in loss of the splenorenal ligament, a key ligament to maintain normal splenic position in the abdomen. Two patients, one with OHVIRA (obstructed hemivagina ipsilateral renal anomaly) syndrome and another who underwent a left nephrectomy during infancy, developed a wandering spleen with acute splenic torsion in the setting of an absent left kidney. This case series aims to increase awareness to the likely predisposition for individuals with an absent left kidney to develop a wandering spleen.
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Affiliation(s)
- Anna Kalathil Thomas
- University of Tennessee Health Science Center, LeBonheur Children's Hospital, 848 Adams Ave. G216, TN, 38103, Memphis, USA.
| | - Rebecca Thomas
- Southern Adventist University, 4881 Taylor Cir, Collegedale, TN, 37315, USA
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Giraud JT, Dingremont C, Gailleton R, Tissier M, Arouch K. [A case report of wandering spleen]. Rev Med Interne 2020; 42:285-287. [PMID: 33341287 DOI: 10.1016/j.revmed.2020.11.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Wandering spleen is a rare condition that occurs when there is an acquired or congenital hypelaxity of the suspensory ligaments of the spleen, resulting in its migration to any abdominal or pelvic position. CASE REPORT A 43-year-old woman presented with symptoms of acute abdominal pain. At physical examination, a splenomegaly was found in the left hypochondria, thereafter followed by a secondary migration of the lump to a periumbilical location. Computed tomography revealed a wandering spleen with vascular pedicle torsion. Splenopexia was perfomed. CONCLUSION A wandering spleen is most frequently observed in children and young women. This rare diagnosis should be considered facing a recurrent abdominal pain syndrome, a splenomegaly accompanied with pain, or a pelvic lump. A wandering spleen may lead to torsion of the vascular pedicle of the spleen, a chronic volvulus with portal hypertension, or even a splenic infarction. The diagnosis is performed by computed tomography. Wandering spleen is treated surgically, by splenopexy or splenectomy.
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Affiliation(s)
- J-T Giraud
- Service de médecine interne, centre hospitalier de Bigorre, 65000 Tarbes, France.
| | - C Dingremont
- Service de médecine interne, centre hospitalier de Bigorre, 65000 Tarbes, France
| | - R Gailleton
- Service de chirurgie digestive, centre hospitalier de Bigorre, 65000 Tarbes, France
| | - M Tissier
- Service d'imagerie médicale, centre hospitalier de Bigorre, 65000 Tarbes, France
| | - K Arouch
- Service d'imagerie médicale, centre hospitalier de Bigorre, 65000 Tarbes, France
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El-Helou E, Alimoradi M, Sabra H, Naccour J, Zaarour M, Chebli FA, Wakim R, Haddad MM. Splenoptosis in young female, case report. Int J Surg Case Rep 2020; 77:214-218. [PMID: 33171434 PMCID: PMC7653206 DOI: 10.1016/j.ijscr.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 12/26/2022] Open
Abstract
The spleen is normally located in the left hypochondriac region just underneath the 9th to 11th intercostal spaces. Splenoptosis, wandering spleen or floating spleen, is a rare entity in which the spleen migrates from its normal position. The diagnosis is confirmed by imaging modalities. The only definitive treatment is surgical intervention.
Background Splenoptosis is an uncommon disorder defined as the dislodgment of the spleen from its anatomical location in the left hypochondrium to another location in the intraabdominal cavity. This migration is the result of laxity or absence of the ligaments that fix the spleen to surrounding structures. Splenoptosis is either diagnosed after it causes symptoms, or incidentally using different imaging modalities. Surgery is the definite treatment either by splenopexy or splenectomy. Case presentation In the case presented here, we discuss a 17 years old female patient who presented to our institution for acute onset of abdominal pain, mainly suprapubic, occurring for 4 days. Ultrasound showed a suspicious right pelvic mass, which was found to be a wandering spleen with pedicle torsion. The patient was treated surgically by splenectomy. Conclusion We report this rare case to encourage physicians to keep this etiology in mind as part of the differential diagnosis of unspecific abdominal pain.
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Affiliation(s)
- Etienne El-Helou
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Mersad Alimoradi
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Hassan Sabra
- General Surgery Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Jessica Naccour
- Emergency Medicine Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Mariana Zaarour
- Anatomic Pathology Department, Faculty of Medical Sciences, Lebanese University, Mount Lebanon, Lebanon.
| | - Fares A Chebli
- Obstetrics and Gynaecology Department, Mount Lebanon Hospital, Mount Lebanon, Lebanon.
| | - Raja Wakim
- General Surgery Department, Mount Lebanon Hospital, Mount Lebanon, Lebanon.
| | - Marwan M Haddad
- Radiology Department, Mount Lebanon Hospital, Mount Lebanon, Lebanon.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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