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Eleiwi M, Atatri Y, Younis O, Zuhd J, Awadghanem A, Qashoo A, Sholi S, Bustame S. Wandering Spleen Torsion: A Diagnostic Challenge. Cureus 2024; 16:e53552. [PMID: 38445142 PMCID: PMC10913703 DOI: 10.7759/cureus.53552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
Wandering spleen, or hypermobile spleen, arises from the elongation or maldevelopment of the spleen's suspensory ligaments. This condition is a rare clinical entity, primarily affecting children, with a higher prevalence among adult females in the active reproductive age group. Manifestations may include an asymptomatic abdominal mass or intermittent abdominal discomfort due to the torsion and subsequent spontaneous detorsion of the spleen. This case report details the presentation of a 14-year-old female initially misdiagnosed as having gastroenteritis who later experienced acute abdomen. Subsequent ultrasonography and computed tomography scan revealed splenic torsion, confirmed during exploratory laparotomy, which demonstrated an infarcted spleen. The definitive therapeutic intervention was a total splenectomy. This clinical entity should be taken into account in the differential diagnosis of acute abdominal pain in order to aid in early diagnosis and management. This could allow us to avoid splenectomy whenever possible and instead do splenopexy, especially in pediatric cases, as the spleen plays a crucial role in the reticuloendothelial system.
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Affiliation(s)
- Malak Eleiwi
- Medicine, An-Najah National University Hospital, Nablus, PSE
| | - Yazid Atatri
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Omar Younis
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Jehad Zuhd
- Anesthesia, An-Najah National University Hospital, Nablus, PSE
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Ahmed Awadghanem
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Ahmad Qashoo
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Suha Sholi
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Samer Bustame
- Pediatric Surgery, An-Najah National University Hospital, Nablus, PSE
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
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Kozman M, Ali F, Keller B, Hershey D. Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis. Pediatrics 2022; 149:186867. [PMID: 35485171 DOI: 10.1542/peds.2020-016469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Maggie Kozman
- Departments of Internal Medicine.,Pediatrics.,Division of Pediatrics Hospital Medicine, Rady Children's Hospital San Diego, Department of Pediatric Hospital Medicine, San Diego, California.,Departments of Internal Medicine and Pediatrics, Harbor UCLA Medical Center Internal Medicine and Pediatrics, Los Angeles, California
| | | | - Benjamin Keller
- Pediatric Surgery, University of California San Diego, San Diego, California
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Jha AK, Bhagwat S, Dayal VM, Suchismita A. Torsion of spleen and portal hypertension: Pathophysiology and clinical implications. World J Hepatol 2021; 13:774-780. [PMID: 34367498 PMCID: PMC8326160 DOI: 10.4254/wjh.v13.i7.774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/28/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
The displacement of spleen from its normal location to other places is known as wandering spleen (WS) and is a rare disease. The repeated torsion of WS is due to the presence of long pedicle and absence/laxity of anchoring ligaments. A WS is an extremely rare cause of left-sided portal hypertension (PHT) and severe gastric variceal bleeding. Left-sided PHT usually occurs as a result of splenic vein occlusion caused by splenic torsion, extrinsic compression of the splenic pedicle by enlarged spleen, and splenic vein thrombosis. There is a paucity of data on WS-related PHT, and these data are mostly in the form of case reports. In this review, we have analyzed the data of 20 reported cases of WS-related PHT. The mechanisms of pathogenesis, clinico-demographic profile, and clinical implications are described in this article. The majority of patients were diagnosed in the second to third decade of life (mean age: 26 years), with a strong female preponderance (M:F = 1:9). Eleven of the 20 WS patients with left-sided PHT presented with abdominal pain and mass. In 6 of the 11 patients, varices were detected incidentally on preoperative imaging studies or discovered intraoperatively. Therefore, pre-operative search for varices is required in patients with splenic torsion.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Sameer Bhagwat
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Vishwa Mohan Dayal
- Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna 800014, India
| | - Arya Suchismita
- Department of Paediatric Hepatology, Institute of Liver and Biliary Sciences, Delhi 110070, India
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Abstract
Wandering spleen is a rare condition that accounts for less than 0.25% of all indications for splenectomy. It is characterized by ectopic localization of the spleen owing to the lack or weakening of its ligaments. Torsion is the most common complication due to its long pedicle and high mobility, which may result in acute abdomen. We report a case of torsion in a wandering spleen in a 28-year-old male presenting with an acute abdomen that was treated by splenectomy.
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Affiliation(s)
- Nwashilli N Jude
- Department of Surgery, University of Benin Teaching Hospital, Benin, Edo State, Nigeria. E-mail.
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Dème H, Akpo LG, Fall S, Badji N, Ka I, Guèye ML, Touré MH, Niang EH. [Torsion of wandering spleen in a teenager: about a case]. Pan Afr Med J 2016; 24:15. [PMID: 27583079 PMCID: PMC4992398 DOI: 10.11604/pamj.2016.24.15.7554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/18/2015] [Indexed: 11/11/2022] Open
Abstract
Wandering or migrating spleen is a rare anomaly which is usually described in children. Complications, which include pedicle torsion, are common and can be life-threatening. We report the case of a 17 year-old patient with a long past medical history of epigastric pain suffering from wandering spleen with chronic torsion of the pedicle. The clinical picture was marked by spontaneously painful epigastric mass, evolved over the past 48 hours. Abdominal ultrasound objectified heterogeneous hypertrophied ectopic spleen in epigastric position and a subcapsular hematoma. Doppler showed a torsion of splenic pedicle which was untwisted 2 turns and a small blood stream on the splenic artery. Abdominal CT scan with contrast injection showed a lack of parenchymal enhancement of large epigastric ectopic spleen and a subcapsular hematoma. The diagnosis of wandering spleen with chronic torsion of the pedicle complicated by necrosis and subcapsular hematoma was confirmed. The patient underwent splenectomy. The postoperative course was uneventful. We here discuss the contribution of ultrasound and CT scan in the diagnosis of wandering spleen with chronic torsion of the pedicle.
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Affiliation(s)
- Hamidou Dème
- Service de Radiologie et Imagerie Médicale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Léra Géraud Akpo
- Service de Radiologie et Imagerie Médicale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Seynabou Fall
- Service de Médecine Interne, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Nfally Badji
- Service de Radiologie et Imagerie Médicale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Ibrahima Ka
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
| | | | | | - El Hadj Niang
- Service de Radiologie et Imagerie Médicale, CHU Aristide Le Dantec, Dakar, Sénégal
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Sato M, Miyaki Y, Tochikubo J, Onoda T, Shiiya N, Wada H. Laparoscopic splenectomy for a wandering spleen complicating gastric varices: report of a case. Surg Case Rep 2015; 1:3. [PMID: 26943371 PMCID: PMC4747945 DOI: 10.1186/s40792-014-0003-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/14/2014] [Indexed: 12/18/2022] Open
Abstract
Wandering spleen is a rare clinical entity, and its chronic torsion of the vascular pedicle result in splenic vein occlusion leading to gastric varices. Here, we present a case of wandering spleen complicating gastric varices in a 40-year-old female. Three-dimensional CT (3D-CT) clearly showed the disruption of the splenic vein at the origin of the vascular pedicle and collateral development of the gastric varices. The patient was electively treated with laparoscopic splenectomy. Difficulty of prediction of the splenic vein recanalization to improve the varices was the reason for the use of splenectomy versus splenopexy. The varices were successfully diminished 3 months after the surgery. After review of cases of complicating gastric varices in the literatures, splenectomy is still a secure way to treat an adult patient with wandering spleen with complicating gastric varices.
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Affiliation(s)
- Masanori Sato
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Yuichiro Miyaki
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Junpei Tochikubo
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Takanobu Onoda
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Hidetoshi Wada
- First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashiku, Hamamatsu, Shizuoka, 431-3192, Japan.
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Lombardi R, Menchini L, Corneli T, Magistrelli A, Accinni A, Monti L, Tomà P. Wandering spleen in children: a report of 3 cases and a brief literature review underlining the importance of diagnostic imaging. Pediatr Radiol 2014; 44:279-88. [PMID: 24407229 DOI: 10.1007/s00247-013-2851-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 09/06/2013] [Accepted: 10/02/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Wandering spleen is a rare condition in children that is often caused by loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication. OBJECTIVE To provide up-to-date information on the diagnosis, clinical management and diagnostic imaging approaches for wandering spleen in infants and children and to underline the importance of color Doppler US and CT in providing important information for patient management. MATERIALS AND METHODS We report a series of three children with wandering spleen treated at our children's hospital over the last 6 years. All three underwent clinical evaluation, color Doppler US and CT and were surgically treated. We also reviewed 40 articles that included 55 patients younger than 18 years reported in the Medline database from 2002 to 2012. RESULTS We correlated pathological data with imaging findings. Color Doppler US, the first imaging modality in investigating abdominal symptoms in children with suspected wandering spleen, yielded a diagnostic sensitivity of 54.9%, whereas CT achieved about 71.7%. CONCLUSION Radiologic evaluation has a major role in confirming the diagnosis of a suspected wandering spleen and avoiding potentially life-threatening complications requiring immediate surgery.
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Affiliation(s)
- Roberta Lombardi
- Department of Radiology, Bambino Gesù Pediatric Hospital, P.zza S. Onofrio, 4-00165, Rome, Italy,
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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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 02/10/2013] [Indexed: 12/30/2022] Open
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Anyfantakis D, Kastanakis M, Katsougris N, Papadomichelakis A, Petrakis G, Bobolakis E. Acute torsion of a wandering spleen in a post-partum female: A case report. Int J Surg Case Rep 2013; 4:675-7. [PMID: 23792478 DOI: 10.1016/j.ijscr.2013.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/06/2013] [Accepted: 05/10/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Wandering spleen is a rare condition characterized by ectopic position of the spleen due to the absence or laxity of peritoneal ligaments that hold the organ within the left upper quadrant. Lower abdomen and pelvis are the most common locations of the wandering spleen. The disorder usually remains asymptomatic. PRESENTATION OF CASE We present a case of acute abdomen due to torsion of a wandering spleen in a primiparus, healthy female shortly after delivery. Diagnosis was based on ultrasonography and computed tomography and was confirmed later on surgery. Total splenectomy was performed successfully. DISCUSSION The rarity of the condition and the nonspecific clinical symptoms and signs make prompt diagnosis challenging. CONCLUSION Prompt recognition and intervention are necessary in order to minimize the risk of complications. For this reason physicians have to include the condition in the differential diagnosis of acute abdominal pain especially when they encounter females in a pregnancy or post-natal period.
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