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Ganarin A, Fascetti Leon F, La Pergola E, Gamba P. Surgical Approach of Wandering Spleen in Infants and Children: A Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:468-477. [PMID: 33428514 DOI: 10.1089/lap.2020.0759] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Splenopexy has been proposed as the treatment of choice in case of wandering spleen (WS). We report our experience and review the current literature focusing on surgical management and outcomes of children affected by WS. Materials and Methods: Data regarding demographics, clinical manifestations, diagnosis, and treatment of children treated for WS at our Institution were analyzed. Systematic review was registered on Prospero (CRD42018089971). Scientific databases were searched using defined keywords. Articles were selected using predefined exclusion and inclusion criteria. Analysis was conducted adding our center's cases. Results: One hundred sixty-six articles were included in the review, 197 cases were analyzed, 3 of which unpublished. Female/male ratio was 1.5:1 and median age at diagnosis was 8 years. Most frequent clinical manifestation was isolated abdominal pain (42.6%). Torsion of splenic pedicle was diagnosed in 56.3%. Among surgical procedures, 39% underwent splenopexy and 54.8% underwent splenectomy. In case of splenopexy, the most commonly used techniques were using of a mesh (45.5%) or creation of a retroperitoneal pouch (30.9%). In 48.2% of splenopexies, minimally invasive surgery (MIS) was used. Splenopexy was effective in 94.8% (88% considering only cases with a spleen torsion). Conclusion: WS is a rare condition potentially leading to torsion of the spleen. This entity has to be kept in mind as a differential diagnosis in case of abdominal pain. Splenopexy should be the treatment of choice; its success rate in terms of preserved spleens can be affected by the presence of a torted organ. Retroperitoneal pouch or mesh fixation are the most preferred techniques. Authors recommend MIS approach.
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Affiliation(s)
- Alba Ganarin
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Enrico La Pergola
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
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Bunyamin G, Doğan E, Özdemir M, Mihriban K. The ectopic spleen-incidental finding on pelvic magnetic resonance imaging. PRAXIS MEDICA 2021. [DOI: 10.5937/pramed2102055g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The ectopic spleen (ES) is a rare variation occurred depend on the absence or laxity of the suspensory ligaments. The ES is a rarely diagnosed clinical condition. Less than 500 symptomatic patients have been reported. Less than 0.25% of splenectomies are performed on the ES. Patients are usually asymptomatic. It's diagnosed incidentally in general. The incidence is not clear. ES incidence is reported less than 0.5%. However, this rate covers all of the relocations. The spleen can be found anywhere in the abdomen or pelvis, depends on the length of the vascular pedicle. The pelvic ES is a rarely encountered situation. Knowing this anomaly is essential for early diagnosis and prevention serious problems such as torsion, infarction and acute abdomen. A 21 years old female patient with ES was presented on pelvic magnetic resonance imaging.
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3
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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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4
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Yakan S, Telciler KE, Denecli AG. Acute Torsion of a Wandering Spleen Causing Acute Abdomen. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Wandering spleen is a rare clinical entity characterised by splenic hypermobility resulting from laxity or maldevelopment of the suspensary gastrosplenic, splenorenal, and phrenicocolic ligaments. Diagnosis is quite difficult because of the lack of symptoms and signs until splenic torsion have occured. In this article, we present and discuss a 23-year-old caucasian woman presenting with acute abdomen, diagnosed as splenic torsion by ultrasound and magnetic resonance imaging and managed surgically.
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Masui D, Fukahori S, Asagiri K, Ishii S, Saikusa N, Hashizume N, Yoshida M, Higasidate N, Sakamoto S, Tsuruhisa S, Tanaka Y, Yagi M. Wandering spleen associated with omphalocele in a neonate: An unusual case with non-operative management. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Flores-Ríos E, Méndez-Díaz C, Rodríguez-García E, Pérez-Ramos T. Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon. J Radiol Case Rep 2015; 9:18-25. [PMID: 26629290 DOI: 10.3941/jrcr.v9i10.2475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Wandering spleen is a rare condition, characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries. Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported. We report a case of wandering spleen associated with mesenteroaxial gastric volvulus, pancreatic volvulus and rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon in a young female.
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Affiliation(s)
- Enrique Flores-Ríos
- Department of Radiology, Hospital Universitario de A Coruña, A Coruña, Spain
| | | | | | - Tania Pérez-Ramos
- Department of Radiology, Hospital Universitario de A Coruña, A Coruña, Spain
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7
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Yoldaş Ö, Karabuğa T, Özsan İ, Şahin E, Limon Ö, Aydın Ü. Laparoscopic splenectomy for a wandering spleen causing chronic pelvic pain. ULUSAL CERRAHI DERGISI 2015; 32:292-294. [PMID: 28149130 DOI: 10.5152/ucd.2015.2850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/16/2014] [Indexed: 11/22/2022]
Abstract
Wandering spleen is a rare condition with a reported incidence of less than 0.5% in which the spleen migrates from its normal anatomical location to any other position in the abdomen. Women constitute 80% of cases and one third of the overall patients are children. It has different clinical presentations such as asymptomatic, painless mass in the abdomen, intermittent abdominal pain and acute abdomen due to torsion of the vascular pedicle. Here we present a case of wandering spleen causing chronic pelvic pain. Laparoscopic splenopexy was the treatment choice but it could not be performed due to huge size of the wandering spleen.
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Affiliation(s)
- Ömer Yoldaş
- Department of General Surgery, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - Türker Karabuğa
- Department of General Surgery, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - İsmail Özsan
- Department of General Surgery, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - Erkan Şahin
- Department of Radiology, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - Önder Limon
- Department of Emergency Medicine, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
| | - Ünal Aydın
- Department of General Surgery, İzmir University School of Medicine, Medicalpark Hospital, İzmir, Turkey
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8
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Maksoud SFA, Swamy N, Khater NH. Tale of a wandering spleen: 1800 degree torsion with infarcted spleen and secondary involvement of liver. J Radiol Case Rep 2014; 8:18-26. [PMID: 25426231 DOI: 10.3941/jrcr.v8i6.1534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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.
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9
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Abstract
INTRODUCTION Wandering 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 because of the laxity of the peritoneal attachments. Many patients with wandering spleen are asymptomatic, hence the condition can be discovered only by abdominal examination or at a hospital emergency department if a patient is admitted to hospital because of severe abdominal pain, vomiting or obstipation. METHODS This article aims to provide a historical overview of wandering spleen diagnostics and surgical treatment supplemented with an analyses of articles on wandering spleen included in the PubMed database. RESULTS One of the first clinical descriptions of a wandering spleen was written by Józef Dietl in 1854. The next years of vital importance are 1877 when A. Martin conducted the first splenectomy and in 1895 when Ludwik Rydygier carried out the first splenopexy to immobilize a wandering spleen. Since that time various techniques of splenectomy and splenopexy have been developed. CONCLUSIONS Introducing medical technologies was a watershed in the development and treatment of wandering spleen, which is confirmed by the PubMed database. Despite the increased number of publications medical literature shows that a wandering spleen still remains a misdiagnosed condition, especially among children.
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Affiliation(s)
- Anita Magowska
- History of Medical Sciences, Poznan University of Medical Sciences, ul. Przybyszewskiego 37A, 61-111, Poznan, Poland.
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10
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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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11
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Abstract
Wandering spleen is rare and is associated with a high incidence of splenic torsion and infarction. Presenting symptoms range from an asymptomatic, incidentally palpated abdominal mass to an acutely ill patient. Because wandering spleen is uncommon in the pediatric population, a heightened awareness of the condition is required for accurate diagnosis and appropriate management. We present a case of a 4-year-old girl who presented with acute abdomen and was surgically confirmed to have a wandering spleen with torsion and complete infarction.
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Affiliation(s)
- Jianping Chu
- Department of Diagnostic Radiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ziping Li
- Department of Diagnostic Radiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Boning Luo
- Department of Diagnostic Radiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jianyong Yang
- Department of Diagnostic Radiology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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12
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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] [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.
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Affiliation(s)
- Ida Di Crosta
- Department of Pediatric Surgery, University Hospital Joan XXIII, 43007, Tarragona, Spain.
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13
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Feroci F, Miranda E, Moraldi L, Moretti R. The torsion of a wandering pelvic spleen: A case report. CASES JOURNAL 2008; 1:149. [PMID: 18783625 PMCID: PMC2553057 DOI: 10.1186/1757-1626-1-149] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 09/10/2008] [Indexed: 11/10/2022]
Abstract
A 15 years old patient was taken to the operative room for an explorative laparotomy due to abdominal pain and a pelvic spleen at preoperative computed tomography: was pointed out the absence of all splenic ligamentous attachments and short gastric vessels with a consequently dislocation of a bigger and congested spleen in the pelvis. This organ, wrapped in the omentum, was in a serious ischemic suffering due to a 720 degrees clock torsion around its exceptionally long pedicle (about 20 cm); besides was confirmed pancreatic body and tail ectopy. Following the derotation, the volume of the organ has decreased but became fixed in above norm dimensions. A total splenectomy was executed.
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Affiliation(s)
- Francesco Feroci
- Division of General Surgery, Ospedale Misericordia e Dolce, P,za dell'ospedale 5, 59100 Prato, Italy.
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14
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Misawa T, Yoshida K, Shiba H, Kobayashi S, Yanaga K. Wandering spleen with chronic torsion. Am J Surg 2008; 195:504-5. [DOI: 10.1016/j.amjsurg.2006.08.083] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Revised: 08/16/2006] [Accepted: 08/16/2006] [Indexed: 12/29/2022]
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15
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Soleimani M, Mehrabi A, Kashfi A, Fonouni H, Büchler MW, Kraus TW. Surgical Treatment of Patients with Wandering Spleen: Report of Six Cases with a review of the literature. Surg Today 2007; 37:261-9. [PMID: 17342372 DOI: 10.1007/s00595-006-3389-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 07/25/2006] [Indexed: 12/19/2022]
Abstract
Wandering spleen, which is defined as a spleen without peritoneal attachments, is a rare disease and a delay in the clinical and/or radiological diagnosis may lead to splenic torsion, infarction, and necrosis. Owing to the physiologic importance of the spleen, especially in children, and the risk of postsplenectomy sepsis, early diagnosis and splenopexy are recommended. In the present article, we describe the results of our management of this rare problem on six patients, and we review all available literature from 1895 to 2005. Briefly, our technique includes flap creation from parietal peritoneum and settlement of spleen in the fossa splenica. Free edges of this flap are stitched to the stomach and the left end of transverse colon and the beginning of the descending colon. The body of the stomach was stitched to the abdominal wall to prevent gastric volvulus, while the fundus region was fixed to the diaphragm to support the spleen. Finally, an omental patch was stitched to the intact abdominal wall above the flap. In conclusion, the procedure of splenopexy without using mesh is considered to be a safe and curative modality for wandering spleen without imposing any undue risk of infection or foreign material reaction.
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Mai W. THE HILAR PERIVENOUS HYPERECHOIC TRIANGLE AS A SIGN OF ACUTE SPLENIC TORSION IN DOGS. Vet Radiol Ultrasound 2006; 47:487-91. [PMID: 17009514 DOI: 10.1111/j.1740-8261.2006.00169.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Diagnosis of acute primary splenic torsion is challenging. The ultrasonographic appearance of this condition has been described, but other splenic diseases, such as diffuse infarction because of thrombosis, can appear very similar. We describe an additional ultrasonographic sign of acute splenic torsion; a triangular hyperechoic area at the hilus between the veins and the splenic parenchyma that is continuous with the hyperechoic mesentery. In a group of animals where acute splenic torsion was part of the ultrasound report differential diagnosis, we compared findings in dogs with torsion with findings in dogs with other splenic conditions. The presence of a hilar hyperechoic perivenous triangle was significantly associated with splenic torsion (P = 0.005). We speculate that this sign is associated with torsion because of the secondary severe, diffuse splenic enlargement. Although not pathognomonic, this sign could be used to more accurately diagnose splenic torsion in light of other findings consistent with this condition.
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Affiliation(s)
- Wilfried Mai
- Section of Radiology, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Ryan Hospital, 3900 Delancey Street, Philadelphia, PA 19104, USA.
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17
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Vázquez JL, Montero M, Díaz F, Muguerza R, Páramo C, Rodríguez-Costa A. Acute torsion of the spleen: diagnosis and management. Pediatr Surg Int 2004; 20:153-4. [PMID: 14758498 DOI: 10.1007/s00383-003-1110-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2003] [Indexed: 11/30/2022]
Abstract
We present a 2-year-old girl with a 24-hour history of abdominal pain, fever, and vomiting. The diagnosis of acute splenic torsion was made by means of color and power Doppler ultrasound. Management of this rare surgical emergency is discussed.
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Affiliation(s)
- José L Vázquez
- Department of Radiology, Complejo Hospitalario Xeral-Cíes, Pizarro 22, 36204, Vigo, Spain.
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Görg C, Seifart U, Görg K. Acute, complete splenic infarction in cancer patient is associated with a fatal outcome. ACTA ACUST UNITED AC 2004; 29:224-7. [PMID: 15290950 DOI: 10.1007/s00261-003-0108-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Splenic infarction frequently occurs in patients with myeloproliferative diseases, endocarditis, and sickle cell anemia. Various sonographic patterns of splenic infarction do exist. but little is known about tumor associated splenic infarction in cancer patients. Between January 1992 and December 2002, 66 patients were diagnosed with splenic infarction by color Doppler sonography (CDS). Ten patients had an underlying solid cancer. Clinical and sonographic data of cancer patients were evaluated retrospectively with regard to age, sex, frequency of thrombotic episodes, splenic size, echomorphology and vascularity of splenic lesions, and follow-up examination. The median age was 53 years (range, 16-73 years). Nine of 10 patients had abdominal metastases, four had evidence of a hypercoagulable state, five had a small spleen (< 7 x 3 cm), and seven had acute complete infarction of the spleen without hilar and parenchymal vessels on CDS. Survival of six patients with acute complete infarction ranged from 1 to 30 days. In cancer patients with splenic infarction, an acute complete infarction is the most common pattern. It is caused predominantly by a hypercoagulable state and is associated with an extremely short survival.
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Affiliation(s)
- C Görg
- Department of Internal Medicine, Philipps-University, Baldingerstrasse, 35043 Marburg, Germany.
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19
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Kessler A, Miller E, Keidar S, Blachar A, Sira LB, Weinberg M, Rachmel A. Mass at the splenic hilum: a clue to torsion of a wandering spleen located in a normal left upper quadrant position. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:527-530. [PMID: 12751865 DOI: 10.7863/jum.2003.22.5.527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Wandering spleen is an extremely rare condition in which the spleen is lacking its normal ligamentous attachments and therefore can move to an ectopic position in the abdomen or pelvis. Wandering spleen predisposes the patient to life-threatening complications due to torsion of the spleen's vascular pedicle, with resulting splenic infarction, portal hypertension, and bleeding. Because of the nonspecific symptoms, imaging plays an important role. To our knowledge, only a few case reports describing wandering spleen in the pediatric population have been published, including 2 cases in infancy. We report a case of splenic torsion in an infant with a preoperative diagnosis made on the basis of color and power Doppler sonography. The diagnosis was confirmed by contrast-enhanced helical computed tomography (CT) and proved at surgery. On sonography, a diffusely hypoechoic spleen and a mass at the splenic hilum representing the torsed splenic pedicle were shown. The splenic hilar mass correlates with the CT "whirl" sign indicative of torsion.
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Affiliation(s)
- Ada Kessler
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Avi, Israel
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20
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Résière D, Habib E, Bellaiche G, Amaro J, Baudel JL, Fouet P. ["Wandering" spleen revealed by hematemesis]. Rev Med Interne 2001; 22:594-5. [PMID: 11433574 DOI: 10.1016/s0248-8663(01)00395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bhasin A, Gulati MS, Kashyap R. Value of power Doppler sonography in the evaluation of torsion in a wandering spleen. JOURNAL OF CLINICAL ULTRASOUND : JCU 2001; 29:60-61. [PMID: 11180188 DOI: 10.1002/1097-0096(200101)29:1<60::aid-jcu11>3.0.co;2-o] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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