Splenic torsion

Splenic torsion, a challenging diagnosis in an adult presenting with acute abdomen

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.

Wandering spleen with torsion and infarction: A case report

Wandering spleen, also known as ectopic spleen, is a rare condition in which the spleen's anatomical location is other than its fixed position in the abdomen's left upper quadrant. The cause of such an abnormality could be due to congenital or acquired factors, which could ultimately lead to torsion and splenic infarct. Given the nonspecific clinical symptoms and the potential complications associated with wandering spleen, computed tomography scans provide a crucial means for proper diagnosis. In this article, we report the case of a 16-year-old female with a diagnosis of wandering spleen with torsion and splenic infarct.

A comprehensive radiologic review of abdominal and pelvic torsions

The clinical manifestations of abdominal and pelvic organ torsion can often be non-specific and can affect a wide range of ages and demographic groups. Radiologists have a key role in not only establishing the diagnosis of organ torsion, but also in the assessment of potential complications. As multiple imaging modalities may be utilized in the evaluation of abdominal and pelvic pain, recognizing the various appearances of organ torsion is important to ensure early diagnosis and thereby reducing patient morbidity and mortality, particularly since abdominal and pelvic organ torsion may not be clinically suspected at the time of initial patient presentation.

Wandering spleen with splenic torsion: Report of two cases

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Anatomical variation of the spleen’s position in the abdomen, is a rare condition called Wandering Spleen (WS).

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WS is a vital differential diagnosis in patients presenting with acute abdomen.

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Concerning the high incidence of splenic torsion in these patients, early recognition is important.

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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.

Wandering spleen: a rare complication of sleeve gastrectomy

The spleen is an intraperitoneal organ typically located in the left upper quadrant. Ectopic ('wandering') spleen refers to the displacement of the spleen from its normal anatomical location to another region in the abdominal cavity or pelvis. It's a relatively rare condition with no clear aetiology. We present, here, a case of a wandering spleen following sleeve gastrectomy in a 23-year-old female patient, whose spleen, prior to this event, was demonstrated by imaging in a normal anatomical position. A splenectomy was performed, and after an uneventful postoperative period, the patient was discharged. No similar case description was found in the relevant medical literature. Possible causes and decision-making process are discussed. We conclude that the wandering spleen phenomenon should be considered in the differential diagnosis of patients presenting with abdominal pain and new abdominal mass following sleeve gastrectomy.

Unusual pseudocyst in a wandering spleen

Pseudocysts of the spleen are rare, generally asymptomatic lesions developing secondary to trauma, infection or infarction. When symptomatic, they typically present as non-specific pain in the left hypochondrium, with or without a palpable lump on clinical examination. However, these conventions fail when they occur in a wandering spleen, making imaging critically important. This report describes an unusual case of a 50-year-old who presented with a large cystic mass in a pelvic spleen; imaging facilitated a successful splenectomy and subsequent histopathology revealed a pseudocyst in a wandering spleen.

Wandering Spleen: An Overview

An ectopic (or "wandering") spleen results from abnormal ligamentous laxity failing to fixate the spleen in its normal location in the left upper quadrant. Ligamentous laxity can be acquired due to conditions, such as splenomegaly or pregnancy, but is often congenital. Because of this laxity, there is an elongated vascular pedicle, which is prone to torsion and resultant splenic infarction. These patients generally present with abdominal pain and other nonspecific symptoms making the diagnosis very difficult to make clinically. As such, the radiologist plays a crucial role in the diagnosis and care of these patients, as often the diagnosis is only considered after imaging.

Torsion of a Wandering Spleen Presenting as Acute Abdomen

Background

Wandering spleen is a rare condition which if uncorrected, can result in torsion and infarction. Clinical presentation of a wandering spleen can vary from asymptomatic abdominal mass to acute abdominal pain. Radiological investigations play a pivotal role in diagnosis as the clinical diagnosis is usually impossible.

Case Report

We present a case of wandering spleen with torsion and complete infarction that occurred in a 32-year-old multiparous female. The diagnosis was established preoperatively on colour Doppler and CT of the abdomen with subsequent confirmation on surgery.

Conclusions

Wandering spleen is a rare clinical condition which can present as acute abdomen. An increased awareness of this entity together with the timely use of ultrasound and CT of the abdomen can play an important role in preoperative diagnosis and surgical management.

Dynamic MRI in the diagnosis and post surgical evaluation of wandering spleen

Wandering spleen is a rare but potentially clinically significant entity, and may be a cause for a patient presenting with acute abdomen. Because wandering spleen may present with non-specific symptoms and presentation, it can be a difficult diagnosis to make clinically. This paper describes a case report of the use of dynamic Magnetic Resonance Imaging (MRI) in a young woman to confirm the diagnosis of wandering spleen pre-operatively. The patient underwent a splenopexy and a post-operative MRI confirmed the successful surgical fixation of the patient's spleen.

Wandering spleen in an adult man associated with the horseshoe kidney

INTRODUCTION

A wandering spleen occurs when there is a laxity of the ligaments that fix the spleen in its normal anatomical position.

CASE PRESENTATION

This is a case report of a wandering spleen with horseshoe kidney in a 29-year-old male admitted with acute lower abdominal pain and vomiting to emergency department of Shariati hospital in Isfahan province. Sonographic examination showed a homogeneous 21 × 15 × 8 cm mass in the lower part of the abdomen and pelvis associated with a horseshoe kidney. Laparotomy confirmed the clinical and ultrasound findings.

CONCLUSIONS

The association of horseshoe kidney with a wandering spleen in this case may be due to an embryological anomaly.

Abdominal twists and turns: part 2, solid visceral torsions with pathologic correlation

OBJECTIVE

The solid abdominal viscera are secured in place by various suspensory ligaments. Laxity or incomplete development of these anchoring ligaments can lead to hypermobility and predispose the patient to torsion-related ischemic pathology. The clinical symptoms of solid visceral intraabdominal torsions are nonspecific. A prompt diagnosis is critical to avoid life-threatening consequences of prolonged visceral ischemia. Abdominal torsions are rarely diagnosed clinically, and it is often the responsibility of the radiologist to recognize and make the diagnosis through cross-sectional imaging. This article reviews the imaging spectrum, radiologic-pathologic correlations, and therapeutic implications of solid visceral intraabdominal torsions, including some unusual solid organ and abdominal fat torsions.

CONCLUSION

The clinical presentation of solid visceral intraabdominal torsion is nonspecific and radiologists are relied on to make this diagnosis on cross-sectional imaging studies. Recognition of the predisposing factors and imaging spectrum of intraabdominal torsions is essential to help direct timely intervention in these potentially life-threatening entities.

Torsion of a wandering spleen

Wandering spleen is a rare condition defined as a mobile spleen only attached with its pedicle. It can be complicated by a volvulus, which is a surgical abdominal emergency. Preventing infarction is the aim of a prompt surgery that can preserve the spleen and then proceed to splenopexy. We report a rare case of torsion of a wandering spleen associated with a dolichosigmoοd.

Postcesarean splenic torsion

OBJECTIVE

Splenic torsion is an exceedingly rare complication in pregnancy. We present a case of acute splenic torsion that manifested after cesarean section and which was successfully treated with laparotomy with splenectomy and partial pancreatectomy.

CASE REPORT

A 35-year-old, gravida 7, para 1, aborta 5, woman presented at our hospital for planned cesarean section at 38 weeks of gestation. Thrombocytopenia was noted antenatally and enlarged spleen with smooth surface and contour was observed at the conclusion of cesarean section. One day after delivery, dyspnea and left upper abdominal pain developed. Abdominal computed tomography showed a huge abscess in the left anterolateral abdomen and bilateral pleural effusion. Acute splenic torsion was highly suspected, but the patient refused surgical intervention until the condition exacerbated 21 days after delivery. Splenic pedicle strangulation with thrombosis, a severely ischemic spleen with rupture and distal pancreatic necrosis were noted during emergent laparotomy. She had an uneventful recovery and was discharged 5 days after left splenectomy and partial pancreatectomy.

CONCLUSION

Splenic torsion is a rare cause of acute abdominal pain during pregnancy or postpartum, and the symptoms vary depending on the degree of torsion. Early involvement of many complementary specialty services enabled early recognition of this rare entity and timely definitive treatment.