Wandering spleen with torsion and infarction: A case report

A case of torsed wandering spleen presenting as perforated acute appendicitis: A case report and literature review

INTRODUCTION

Wandering spleen (WS) is a rare circumstance characterized via exaggerated splenic mobility because of absent or lax suspensory ligaments. It predisposes the spleen to torsion, that could purpose infarction, rupture, or gangrene, requiring urgent intervention.

PRESENTATION OF CASE

We report a 10-year-old girl with a three-day history of acute abdominal pain, vomiting, and fever. Physical examination revealed diffuse tenderness, predominantly in the right lower quadrant (RLQ), mimicking appendicitis. Ultrasound and CT showed WS with torsion, showing the characteristic whirl sign. Emergency laparotomy revealed a 720-diploma splenic torsion with necrosis, necessitating splenectomy. The patient had an uneventful recovery and was discharged on postoperative day five.

DISCUSSION

WS is an extraordinary entity (<0.2 % occurrence) with a bimodal age distribution, often affecting adolescents and girls. It can be congenital or acquired and presents variably, from asymptomatic cases to acute abdomen. Torsion leads to vascular compromise, requiring prompt surgical intervention. This case was very interesting to the surgical team for its atypical presentation and its resemblance to perforated appendicitis.

CONCLUSION

WS must be considered in cases of acute abdomen with an absent spleen on imaging. Early recognition and surgical intervention are essential to prevent complications in patients with acute abdomen. Ultrasound and CT are critical for early detection and differentiation from different abdomen emergencies.

Torsion of a wandering spleen, a rare cause of acute abdomen: A case report

INTRODUCTION

"Wandering spleen" a condition in which the spleen's suspensory ligaments are under developed or slack is characterized mainly by splenic hypermobility and loss of fixation. A variety of clinical presentations of this condition has been described; from an incidental finding in imaging surveys to acute, chronic, or intermittent symptoms due to splenic torsion. For these individuals, there are two possible treatment options: splenectomy or splenopexy.

CASE PRESENTATION

Here we present a case of a 16 year old female patient presented with acute abdomen and underwent exploratory laparotomy and splenectomy for gangrenous volvulated wandering spleen.

CLINICAL DISCUSSION

Splenic suspensory ligament abnormalities, frequently referred to as a "wandering" spleen, are the cause of predisposition. However, because the patient usually exhibits no symptoms until splenic torsion occurs, diagnosing of a "wandering" spleen is challenging. Diagnosis is mainly using imaging modalities; color doppler study or compute tomography scan which are done usually once the patient is symptomatic.

CONCLUSION

High index of suspicion and early detection (along with other factors) might allow splenic preservation especially in children.

Wandering spleen combined with pedicle torsion and splenic infarction: a rare case report and literature review

Wandering spleen (WS) concurrent with splenic pedicle torsion and infarction has been described rarely. We reported our experience in diagnosing and treating such a condition in a 16-year-old girl with acute abdominal pain. A plain CT scan showed the wandering of the spleen from the left upper quadrant. Contrast-enhanced CT indicated dilatation and distortion in the splenic vein, a counterclockwise "whirl sign" in the splenic pedicle, pancreatic tail torsion, and splenic infarction. The patient was diagnosed with WS combined with splenic pedicle torsion and splenic infarction and underwent splenectomy for treatment. She showed a satisfactory outcome during the follow-up. To enhance our understanding of it, we performed a comprehensive literature research to summarize the clinical manifestations, treatment options, and outcomes among adolescent patients.

Torsion of a wandering spleen in a pregnant patient presented with acute abdomen: A case report

INTRODUCTION AND IMPORTANCE

Wandering spleen may result in torsion or splenomegaly, which causes symptoms such as intestinal obstruction, nausea, vomiting, and swelling in the abdomen. There are few reports of wandering spleen torsion in pregnant mothers. The diagnosis and presentation of splenic torsion is variable and challenging during pregnancy. Herein, we present a case of torsion of a wandering spleen in a 30-year-old pregnant patient.

CASE PRESENTATION

A 30-year-old female presented with a sudden onset of abdominal pain of three days' duration. There was lower abdominal mass and tenderness. Intraoperative findings revealed enlarged spleen located over the lower abdominal cavity with six times clockwise rotation of the splenic pedicle over itself. A splenectomy was performed. The patient was discharged on the 7th postoperative day and had an uneventful postoperative recovery.

CLINICAL DISCUSSION

Patient presentation could be asymptomatic, chronic left abdominal pain or symptoms and signs of complication. The most common complication of wandering spleen is torsion (Abell, n.d.). Splenic torsion is evidenced by mucosal bleeding, hematemesis, anemia or thrombocytopenia in our patient platelets level was 111,000 cells/μl which suggests vascular thrombosis. The other peculiarity during pregnancy is torsion of the spleen have higher mortality reaching up to 41 % (Lewis and Wolskel, 1962) which may be from delay in diagnosis or misdiagnosis.

CONCLUSION

There is high mortality associated with splenic torsion in pregnant patient reported in the literature. One of the explanations is misdiagnosis and delay in diagnosis of torsion of a wandering spleen in a pregnant patient.

Wandering Spleen with Splenic Torsion: Unusual Cause of Acute Abdomen

INTRODUCTION

Wandering spleen is a rare condition characterised by laxity or lack of splenic ligaments as a result of acquired or congenital causes. There is a possibility of misdiagnosis due to its vague symptoms. In order to make a proper diagnosis, imaging techniques including abdominal ultrasonography and CT scanning are essential. Surgery is the main option of management. If the spleen is viable and there is no thrombosis in the splenic veins, splenopexy is the preferred surgical procedure. Alternatively, splenectomy plus prophylactic antibiotic and vaccination usage may be employed if spleen has infarction.

CASE PRESENTATION

A 12-year-old male child who had previously experienced constipation, mucoid diarrhoea, and abdominal distention arrived with crampy abdominal pain that had lasted for four days. The patient was tachycardic with abdominal tenderness. Whirlpool sign and lack of a spleen in its normal position were visualized on an abdominal ultrasound. The spleen was located intraoperatively in the lower abdomen, adhered to the ileum and appendix. It was 720° twisted and had necrotic areas. The patient underwent an appendectomy with splenectomy with a smooth post-operative course; combination meningococcal and pneumococcal vaccines were administered; and antibiotic prophylaxis was started for the patient.

CONCLUSION

High clinical suspicion and the use of imaging modalities like ultrasound and CT scan are extremely crucial to diagnose wandering spleen and perform splenic salvage surgery because its clinical diagnosis is challenging.