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Ferrara D, Vallone G, Russo S, Rossi E, Riccio C, Rinaldo AM, Zeccolini R, Zeccolini M, Esposito F. Volvulus of a wandering spleen in a pediatric patient. Radiol Case Rep 2024; 19:2864-2867. [PMID: 38689812 PMCID: PMC11058064 DOI: 10.1016/j.radcr.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 05/02/2024] Open
Abstract
Wandering spleen is a rare condition in children that is often caused by the loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication. A 13-year-old boy who had been showing abdominal pain in the hypogastric region accompanied by vomit and an enormous tumefaction in the suprapubic region came to our observation. Considering the ovoid morphology at ultrasound exam, the echostructure and the marked reduction of parenchymal vascularization, suspicion for torsion of an ectopic spleen arose. Ultrasound evaluation has a primary role in the diagnosis of a suspected wandering spleen and, to avoid potentially life-threatening complications, immediate surgery is often times required.
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Affiliation(s)
- Dolores Ferrara
- Department of Radiology, “A.O.R.N. Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Gianfranco Vallone
- Life and Health Department “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Silvana Russo
- Pediatric Surgery Unit, “A.O.R.N. Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Eugenio Rossi
- U.O.S.D. Diagnostic Imaging P.O. Pausilipon, “A.O.R.N. Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Ciro Riccio
- Department of Advanced Biomedical Sciences, University of Naples Federico II Unina, Naples, Italy
| | - Andrea Maria Rinaldo
- Department of Advanced Biomedical Sciences, University of Naples Federico II Unina, Naples, Italy
| | - Raffaele Zeccolini
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Massimo Zeccolini
- Department of Radiology, “A.O.R.N. Santobono-Pausilipon” Children Hospital, Naples, Italy
| | - Francesco Esposito
- U.O.S.D. Division of Emergency Imaging Department “A.O.R.N. Santobono-Pausilipon”, Children Hospital, Naples, Italy
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Shibiru YA, Wondimu S, Almaw W. Wandering spleen presenting in the form of right sided pelvic mass and pain in a patient with AD-PCKD: a case report and review of the literature. J Med Case Rep 2024; 18:259. [PMID: 38790071 PMCID: PMC11127297 DOI: 10.1186/s13256-024-04580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not. CASE PRESENTATION We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful. CONCLUSION Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.
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Wang Z, Peng C, Wu D, Wang K, Chen Y. Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction. BMC Pediatr 2022; 22:440. [PMID: 35864485 PMCID: PMC9306085 DOI: 10.1186/s12887-022-03484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction. Methods From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized. Results There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4–170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient. Conclusions Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03484-y.
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Affiliation(s)
- Zengmeng Wang
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Chunhui Peng
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Dongyang Wu
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Kai Wang
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China
| | - Yajun Chen
- General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China.
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Sun C, Li SL. Successful treatment of floating splenic volvulus: Two case reports and a literature review. World J Clin Cases 2021; 9:8812-8819. [PMID: 34734060 PMCID: PMC8546827 DOI: 10.12998/wjcc.v9.i29.8812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The floating spleen refers to the spleen moving away from the normal anatomical position to other parts of the abdominal cavity.
CASE SUMMARY In this report, we describe two cases of torsion of floating spleen, which were successfully treated by laparoscopic partial splenectomy and retroperitoneal fixation of the residual spleen. The clinical characteristics of previously reported cases are also discussed.
CONCLUSION In conclusion, laparoscopic partial resection of splenic volvulus infarction and extraperitoneal fixation of residual spleen are safe and reliable.
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Affiliation(s)
- Chi Sun
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Suo-Lin Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Thomas AK, Thomas R. The likely association between wandering spleen and absent left kidney. Emerg Radiol 2021; 28:431-435. [PMID: 33417114 DOI: 10.1007/s10140-020-01895-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
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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Abaszadeh F, Taebi M, Nikzad Jamnani H. Torsion of Wandering Spleen Attached to the Omentum: A Rare Case Report from Iran. Int J Gen Med 2020; 13:333-336. [PMID: 32612378 PMCID: PMC7322114 DOI: 10.2147/ijgm.s248259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/09/2020] [Indexed: 12/28/2022] Open
Abstract
Background Wandering spleen is a rare condition with less than 0.2% prevalence, and it is the cause of 0.25% of total splenectomies. This condition happens as a result of the lack or looseness of the spleen suspensory ligaments, and it may manifest as an acute abdomen due to the spleen becoming twisted around its vascular base. Case Presentation This study reports the case of a wandering spleen attached to the omentum (with blood supply from the omentum) in the pelvic area, with ectopic appendix (located in the right upper quadrant), ectopic liver (located in the abdominal midline), and ectopic stomach (located in the right upper abdominal region), in a 15-year-old male complaining about abdominal pain, nausea, vomiting, and lack of appetite, who was referred to the hospital. The patient underwent laparotomy with the diagnosis of acute abdomen; the twisted ectopic spleen in the pelvis was removed and appendectomy was also performed. The clinical manifestations of wandering spleen vary extensively, and its presurgical diagnosis is difficult in the absence of radiological studies. Therefore, spleen torsion has to be considered as a diagnosis for acute abdomen in order to prevent necrosis of the spleen and other related complications. Conclusion Wandering spleen should be borne in mind for patients presenting with a palpable intra-abdominal mass causing acute or intermittent abdominal symptoms.
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Affiliation(s)
- Farzad Abaszadeh
- Department of Operation Room Nurse, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mozhgan Taebi
- Department of Anesthesiology, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Chang YL, Lin J, Li YH, Tsao LC. Unusual association of Axenfeld-Rieger syndrome and wandering spleen: A case report. World J Clin Cases 2020; 8:1502-1506. [PMID: 32368543 PMCID: PMC7190964 DOI: 10.12998/wjcc.v8.i8.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Axenfeld-Rieger syndrome (ARS) is an autosomal dominant genetic disease characterized by ocular developmental disorders and its association with torsion of wandering spleen (WS) has not been reported to date to the best of our knowledge. This study aimed to describe a rare case of ARS observed at our emergency department.
CASE SUMMARY A 25-year-old female presented with a constant lower abdominal pain of increasing severity. Diagnostic computed tomography with intravenous contrast material showed a non-homogenously enhanced splenic parenchyma with a twisted vascular pedicle. Further, an emergent laparoscopic exploration was performed, and an ischemic spleen without its normal ligamentous attachments was noted. Notably, the spleen did not regain its normal vascularity after detorsion; thus, we performed the laparoscopic total splenectomy. The postoperative course was uneventful, and the patient was discharged on the 5th postoperative day. This case demonstrates a rare association of WS and ARS.
CONCLUSION Early diagnosis of WS in the emergency department is important to prevent pedicle torsion or splenic necrosis and to avoid splenectomy.
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Affiliation(s)
- Yi-Lin Chang
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Joseph Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Yu-Hsien Li
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
| | - Lien-Cheng Tsao
- Department of General Surgery, Changhua Christian Hospital, Changhua 50006, Taiwan
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Costi R, Castro Ruiz C, Romboli A, Wind P, Violi V, Zarzavadjian Le Bian A. Partial splenectomy: Who, when and how. A systematic review of the 2130 published cases. J Pediatr Surg 2019; 54:1527-1538. [PMID: 30665627 DOI: 10.1016/j.jpedsurg.2018.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/05/2018] [Accepted: 11/25/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE In order to avoid consequences of total splenectomy (including severe postsplenectomy sepsis), partial splenectomy (PS) is increasingly reported. Without guidelines and indications concerning a rarely-indicated procedure, a review of literature should be an asset. METHODS A systematic review of all PSs from 1960 to December 2017 was performed, with special focus on surgical indications, sites of resection, approaches and techniques of vascular dissection and parenchymal section/hemostasis of the spleen, perioperative morbidity/mortality, including complications compelling to perform total splenectomy. RESULTS Among 2130 PSs, indications for resection were hematological disease in 1013 cases and nonhematological conditions in 1078, including various tumors in 142 and trauma in 184. Parenchymal transection was performed using several techniques through the years, most frequently after having induced partial ischemia by splenic hilum vascular dissection/ligation. 371 laparoscopic/robotic PSs were reported. Rescue total splenectomy was required in 75 patients. CONCLUSIONS Although good results are probably overestimated by such a retrospective review, PS should be considered as a procedure associated with a low morbidity/mortality. Nevertheless, severe complications are also reported, and the need of total splenectomy should not to be minimized. Laparoscopic/robotic procedures are increasingly performed, with good results and rare conversions. TYPE OF STUDY Systematic review. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia.
| | | | - Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Philippe Wind
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France
| | - Vincenzo Violi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia; Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Fidenza, Italia
| | - Alban Zarzavadjian Le Bian
- Service de Chirurgie Générale Digestive, Cancerologique, Bariatrique et Métabolique, Hôpital Avicenne, Bobigny, France; Laboratoire d'Ethique Médicale et de Médecine Légale, Université Paris "Descartes", Paris, France
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Seif Amir Hosseini A, Streit U, Uhlig J, Biggemann L, Kahl F, Ahmed S, Markus D. Splenic torsion with involvement of pancreas and descending colon in a 9-year-old boy. BJR Case Rep 2018; 5:20180051. [PMID: 31131126 PMCID: PMC6519498 DOI: 10.1259/bjrcr.20180051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 02/06/2023] Open
Abstract
Splenic torsion is an uncommon condition becoming clinically apparent when the spleen twists or rotates around the organ's vascular pedicle. In the case of a wandering spleen the organ is only attached to an elongated vascular pedicle while the peritoneal attachments are absent. However, splenic torsion could also occur in patients with abnormal laxity of the splenic peritoneal attachments. We report a case of a splenic torsion due to absence of splenic ligaments with pancreatic volvulus and partial involvement of descending colon in a 9-year-old boy.
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Affiliation(s)
- Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ulrike Streit
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Uhlig
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Lorenz Biggemann
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Fritz Kahl
- Department of General-, Visceral-, and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Saheeb Ahmed
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Duersch Markus
- Department of General-, Visceral-, and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
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Wandering spleen with horseshoe kidney a rare occurrence. Int J Surg Case Rep 2018; 45:96-100. [PMID: 29602063 PMCID: PMC6000907 DOI: 10.1016/j.ijscr.2018.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 01/05/2023] Open
Abstract
Wandering spleen with horseshoe kidney is a rare occurrence with less than 3 cases reported worldwide. Delay in diagnosis would result is increased mortality. Splenopexy is preferred in children with the exception of grossly infarcted spleen. Splenectomy is the treatment of choice in torsion of spleen with infarct.
Introduction Wandering spleen is a rare clinical entity in itself, with only 2 cases reported thus far when correlated with congenital under-development of the kidney, it usually happens due to under development of its surrounding ligaments. Herein we present a case of wandering spleen with underlying congenital deformity of horseshoe kidney which requires splenectomy due to late presentation. Presentation of case A 21 year old lady presented with worsening of chronic abdominal pain for 3 years, associated with nausea and vomiting. Physical examination showed a vague mass located at epigastric region. Consecutively, computed tomography images showed a well-defined, oval, hypoechoic spleen extending from center of abdomen up to epigastric region measuring 15.5 × 13 cm with twisted pedicle. Finally the patient underwent surgical treatment. The intraoperative findings were consistent with computed tomography images. The patient made a full recovery and was discharged well. Discussion Wandering Spleen was first described by Van Horne during autopsy back in 1667. Its location is maintained by peritoneal attachments such as lienorenal, splenocolic, splenophrenic, gastrosplenic and phrenicocolic ligaments. Among which, the gastrosplenic ligament and lienorenal ligaments are of greatest significance. Patient with a wandering spleen may present asymptomatic, with a movable mass in the abdomen, or with chronic or intermittent abdominal pain because of partial torsion and spontaneous de-torsion of the spleen as in our case. When feasible especially in young patients, splenopexy should always be the first consideration but however if gross infarct has occurred then splenectomy is inevitable to save the patient. Conclusion Wandering spleen is a unique surgical entity moreover when appeared in congruence with horseshoe kidney. Its diagnosis should be made in prompt to prevent splenic infarction and to try to salvage with splenopexy especially in younger population. However in patient where splenic torsion with infarction has occurred, splenectomy would be the treatment of choice.
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Urbonas T, Crotty FE, Al-Bahrani A. Torsion of an ectopic spleen: a possible late complication of paraoesophageal hernia repair. ANZ J Surg 2015; 88:E357-E358. [PMID: 26489700 DOI: 10.1111/ans.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tomas Urbonas
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
| | - Fiona E Crotty
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
| | - Ahmed Al-Bahrani
- Department of Surgery, Watford General Hospital, Hertfordshire, UK
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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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Blouhos K, Boulas KA, Salpigktidis I, Barettas N, Hatzigeorgiadis A. Ectopic spleen: An easily identifiable but commonly undiagnosed entity until manifestation of complications. Int J Surg Case Rep 2014; 5:451-4. [PMID: 24973525 PMCID: PMC4147574 DOI: 10.1016/j.ijscr.2014.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/14/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Ectopic spleen is an uncommon clinical entity as splenectomy for treatment of ectopic spleens accounts for less than 0.25% of splenectomies. The most common age of presentation is childhood especially under 1 year of age followed by the third decade of life. PRESENTATION OF CASE The present report refers to a patient with torsion of a pelvic spleen treated with splenectomy. The patient exhibited a period of vague intermittent lower abdominal pain lasted 65 days followed by a period of constant left lower quadrant pain of increasing severity lasted 6 days. On the first 65 days, vague pain was attributed to progressive torsion of the spleen which resulted in venous congestion. On the last 6 days, exacerbation of pain was attributed to irreducible torsion, infraction of the arterial supply, acute ischemia, strangulation and rupture of the gangrenous spleen. Diagnosis was made by CT which revealed absence of the spleen in its normal position, a homogeneous pelvic mass with no contrast enhancement, free blood in the peritoneal cavity, and confirmed by laparotomy. DISCUSSION Clinical manifestations of ectopic spleen vary from asymptomatic to abdominal emergency. Symptoms are most commonly attributed to complications related to torsion. Operative management, including splenopexy or splenectomy, is the treatment of choice in uncomplicated and complicated cases because conservative treatment of an asymptomatic ectopic spleen is associated with a complication rate of 65%. CONCLUSION Although an ectopic spleen can be easily identified on clinical examination, it is commonly misdiagnosed until the manifestation of complications in adulthood.
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Affiliation(s)
| | | | - Ilias Salpigktidis
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
| | - Nikolaos Barettas
- Department of General Surgery, General Hospital of Drama, Drama, Greece.
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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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Bouzaidi K, Daghfous A, Ben Ali M, Karma S, Rezgui Marhoul L. [Infarction of a wandering spleen - a case report]. Presse Med 2013; 43:225-8. [PMID: 24184280 DOI: 10.1016/j.lpm.2013.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/11/2013] [Accepted: 04/30/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Khaled Bouzaidi
- Hôpital MT Maâmouri, service d'imagerie médicale, 8000 Nabeul, Tunisie
| | - Alifa Daghfous
- Centre des grands brulés, service d'imagerie médicale, 2013 Ben Arous, Tunisie.
| | - Mechaal Ben Ali
- Hôpital MT Maâmouri, service d'anesthésie réanimation, 8000 Nabeul, Tunisie
| | - Sahbi Karma
- Hôpital MT Maâmouri, service d'imagerie médicale, 8000 Nabeul, Tunisie
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