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Caruso MJ, Bidani K, Singh AK. Wandering liver, spleen, and kidney: what the radiologist needs to know. Abdom Radiol (NY) 2023; 48:1854-1861. [PMID: 36752858 DOI: 10.1007/s00261-022-03789-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
The wandering spleen, wandering liver, and wandering kidney are rare diagnoses that can be asymptomatic or are associated with nonspecific symptoms, making the clinical diagnosis elusive. In addition, given the small number of cases, these conditions are not well understood. Major complications of wandering spleen result from torsion of the vascular pedicle with resultant ischemia, physiologic dysfunction, and/or infarction. Wandering liver is commonly associated with bowel obstruction, particularly colonic volvulus, with very rare reports of hepatic ischemia or infarct. Wandering kidneys are not commonly associated with serious complications. In many cases, the wandering spleen, liver or kidney can be found in their anatomic position on static imaging and are only diagnosed during ultrasound or with serial radiographic or cross-sectional imaging with different patient positioning, or with prior studies demonstrating different locations of the involved organ. Treatment approaches for uncomplicated wandering spleen, liver, or kidney include watchful waiting and splenopexy, hepatopexy, or nephropexy, respectively. Complicated wandering spleens are treated with splenectomy. Given the variable clinical presentation of these conditions, imaging plays a pivotal role in diagnosing these rare and often incidentally discovered phenomena.
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Affiliation(s)
- Michael J Caruso
- Department of Radiology, UMass Memorial Medical Center, Worcester, USA
| | - Khyati Bidani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ajay Kumar Singh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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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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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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Leci-Tahiri L, Tahiri A, Bajrami R, Maxhuni M. Acute abdomen due to torsion of the wandering spleen in a patient with Marfan Syndrome. World J Emerg Surg 2013; 8:30. [PMID: 23915457 PMCID: PMC3751152 DOI: 10.1186/1749-7922-8-30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 07/23/2013] [Indexed: 11/10/2022] Open
Abstract
Wandering spleen is a very rare defect characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the upper left abdomen. Patient symptomatology is variable and ranges from mere feeling of an abdominal lump to sudden abdominal pain due to infarction. Patients may have subacute to chronic abdominal or gastrointestinal complaints. Because of nonspecific symptoms, clinical diagnosis can be difficult; hence, imaging plays an important role. A major complication is splenic torsion, which is the cause of acute abdomen. We present a case of acute abdominal pain due to torsion of wandering spleen in a patient with Marfan Syndrome, valvular heart disease, and vertebral anomalies. Preoperative diagnosis was made on the basis of ultrasonography and computed tomography, which was later confirmed on surgery, and treated successfully.
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Affiliation(s)
- Laura Leci-Tahiri
- Clinic of Surgery, University Clinical Center of Kosova, Prishtina, Kosova.
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Samarasinghe RN, Protyniak B, Bethel CA. Wandering spleen and splenic torsion associated with upper respiratory tract infection. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Mehta A, Vana PG, Glynn L. Splenic torsion after congenital diaphragmatic hernia repair: case report and review of the literature. J Pediatr Surg 2013; 48:e29-31. [PMID: 23480945 DOI: 10.1016/j.jpedsurg.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/31/2012] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Abstract
Wandering spleen with torsion, a rare clinical diagnosis, was found to be the cause of chronic abdominal pain in an 11-year-old female with a history of congenital diaphragmatic hernia repaired at three days of age. Doppler ultrasound revealed patent vessels with splenomegaly, and computed tomography (CT) showed an absence of the spleen in the left subphrenic space with torsion at the splenic hilum. Due to the chronicity of pain and risk of ischemia from torsion, open splenopexy with Vicryl mesh was performed. This case report/review of the literature discusses the rarity of this condition, and the importance of timely diagnosis and intervention.
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Affiliation(s)
- Anupama Mehta
- Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
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Torsion of wandering spleen in a woman presenting as emergency. Indian J Surg 2012; 75:59-61. [PMID: 24426389 DOI: 10.1007/s12262-012-0433-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Accepted: 03/04/2012] [Indexed: 10/28/2022] Open
Abstract
Wandering spleen is a very rare condition, it is characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the left hypochondrium. The disorder is not genetic in origin. Instead of ligaments, the spleen is attached by a stalk-like tissue supplied with blood vessels (vascular pedicle). If the pedicle is twisted in the course of the movement of the spleen, the blood supply may be interrupted or blocked (ischemia) to the point of severe damage to the blood vessels (infarction). Because there is little or nothing to hold it in place the spleen "wanders" in the lower abdomen or pelvis where it may be mistaken for an unidentified abdominal mass. "Acquired" wandering spleen may occur during adulthood due to injuries or other underlying conditions that may weaken the ligaments that hold the spleen in its normal position (e.g., connective tissue disease or pregnancy). We here report a case of 40-year-old woman presented to the surgical emergency department, with complaints of colicky abdominal pain of 8 h duration with increasing severity and bilious vomiting. On examination, the patient well built, nourished, conscious, and coherent with profuse sweating. Vital signs were normal excepting high pulse rate of 120/min with blood pressure of 100/60. On examination, she has a central abdominal distention shifting to different quadrants with colicky pain with vague tender firm mass. Abdominal ultrasonography showed ectopic spleen around the umbilicus with variable echos and whorled appearance of the splenic vessels. The patient was prepared for emergency laparotomy. At laparotomy, the spleen was found just below the umbilicus and it was dusky enlarged with infarction with four anticlockwise twists of the long splenic pedicle in the central quadrant of the abdomen. Splenectomy was carried out as there was clear evidence of splenic ischemia after detorsion of the spleen.
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Shimojima K, Okanishi T, Yamamoto T. Marfanoid hypermobility caused by an 862 kb deletion of Xq22.3 in a patient with Sotos syndrome. Am J Med Genet A 2011; 155A:2293-7. [DOI: 10.1002/ajmg.a.34164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 05/19/2011] [Indexed: 12/19/2022]
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Magno S, Nanni L, Retrosi G, Cina A, Gamba PG. An unusual case of acute pancreatitis and gastric outlet obstruction associated with wandering spleen treated by laparoscopic splenopexy. J Laparoendosc Adv Surg Tech A 2011; 21:467-70. [PMID: 21375417 DOI: 10.1089/lap.2010.0417] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Wandering spleen (WS) is an uncommon condition, usually asymptomatic, often recognized as an incidental finding. When symptoms occur, they can vary, although acute abdominal pain is the most common presentation in the pediatric population. In some cases, WS can become a dangerous condition because of the risk of splenic ischemia from persistent pedicle torsion. We describe a case of WS in a 3-year-old boy presenting with vomiting, abdominal swelling, and acute pancreatitis; the diagnosis was obtained by ultrasound and computed tomography. Laparoscopic splenopexy was successfully performed through an extraperitoneal pocket and a Vicryl mesh. To the best of our knowledge, the combination of gastric outlet obstruction and acute pancreatitis has never been reported as presenting symptoms of WS.
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Affiliation(s)
- Stefano Magno
- Department of Surgery, Catholic University School of Medicine, Rome, Italy
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