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Yang JZ, Lim MC, Teo YM, Lee YY. Clinics in diagnostic imaging (218). Singapore Med J 2024; 65:45-50. [PMID: 38212984 PMCID: PMC10863738 DOI: 10.4103/singaporemedj.smj-2022-120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/29/2022] [Indexed: 01/13/2024]
Affiliation(s)
- James Zheng Yang
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Mei Chin Lim
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Yi Ming Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Yang Yang Lee
- Department of Paediatric Surgery, National University Hospital, Singapore
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2
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Ahmed M, Nasir M, Negash A, Haile K. Wandering Spleen with Splenic Torsion: Unusual Cause of Acute Abdomen. Int Med Case Rep J 2022; 15:625-630. [PMID: 36388241 PMCID: PMC9642092 DOI: 10.2147/imcrj.s388271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/26/2022] [Indexed: 09/21/2023] Open
Abstract
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.
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Affiliation(s)
- Muluken Ahmed
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
| | - Mohammed Nasir
- Pediatrics Department, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ashenafi Negash
- Surgery Department, Arba Minch University, Arba Minch, Ethiopia
| | - Kidist Haile
- Pediatrics Department, Arba Minch University, Arba Minch, Ethiopia
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3
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Kumar S, Nepal P, Kumar D, Tirumani SH, Nagar A, Ojili V. Twists and turns in acute abdomen: imaging spectrum of torsions and volvulus. Clin Imaging 2022; 87:11-27. [DOI: 10.1016/j.clinimag.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/03/2022]
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4
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Tang PH, Tangaperumal A, Ahmad NA, Bahari M, Mra A, Teh YG. Torsed wandering spleen as a cause of recurrent abdominal pain in a child. Radiol Case Rep 2022; 17:1794-1797. [PMID: 35369544 PMCID: PMC8965025 DOI: 10.1016/j.radcr.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
Wandering spleen is an uncommon cause of acute abdomen in children. Diagnosis of this condition is challenging due to its non-specific symptoms, varying intensity and protracted history of presentation. Radiographs and ultrasound imaging provide rapid and reliable means to diagnose this condition without exposure to excessive radiation. We present a case of a torsed wandering spleen in a child with recurrent abdominal pain. We highlight the role of imaging in identifying salient radiographic and sonographic signs for diagnosis.
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Affiliation(s)
- Peng Hui Tang
- Department of Radiology, Sabah Women & Children's Hospital, 88450 Kota Kinabalu Sabah
| | - Anithaa Tangaperumal
- Department of Radiology, Sabah Women & Children's Hospital, 88450 Kota Kinabalu Sabah
| | - Nur Aini Ahmad
- Department of Pediatric Surgery, Sabah Women & Children's Hospital, 88450 Kota Kinabalu Sabah
| | - Mughni Bahari
- Department of Pediatric Surgery, Sabah Women & Children's Hospital, 88450 Kota Kinabalu Sabah
| | - Aung Mra
- Department of Surgery, Faculty of Medicine & Health Sciences, University Malaysia Sabah, 88400 Kota Kinabalu, Sabah
| | - Yong Guang Teh
- Department of Radiology, Sabah Women & Children's Hospital, 88450 Kota Kinabalu Sabah.,Department of Radiology, Faculty of Medicine & Health Sciences, University Malaysia Sabah, 88400 Kota Kinabalu, Sabah, Malaysia
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5
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K.S. S, Nikita N, Akash A, Bhandari G. Torsion of a Wandering Spleen Presenting as a Case of Acute Abdomen. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES 2022; 11:425-427. [DOI: 10.14260/jemds/2022/82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Wandering spleen is a rare clinical entity characterized by anomalous position of the spleen in the abdomen due to impaired splenic ligamentous attachments that produce an elongation of the vascular pedicle, favouring a possible volvulus of partial or complete vascular axis. Wandering spleen was first described in autopsies by Johannes Van Horne in 1667. Wandering spleen mainly presents as an asymptomatic mass or seldomly presents as recurrent abdominal pain or acute abdomen. The absence of splenic parenchyma in the left upper quadrant and ectopic location of the spleen can be shown by USG, CT and MRI The procedure of choice in the treatment of wandering spleen is splenopexy. Here we present a case of torsion in a wandering spleen in a 32 years old female. Wandering spleen is a rare clinical entity characterized by anomalous position of the spleen in the abdomen due to impaired splenic ligamentous attachments that produce an elongation of the vascular pedicle, favouring a possible volvulus of partial or complete vascular axis.1 Its aetiology is not clear. Congenital factors exist such as an alteration in the development of the dorsal mesogastrium2 and acquired factors such as hormonal changes during pregnancy,3 abdominal wall weakness, splenomegaly. Clinical presentation is variable, from asymptomatic to chronic abdominal pain or acute abdomen. The most common complication is acute torsion of the splenic pedicle causing acute abdominal pain.
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6
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Midha G, Surendran S, Yacob M, Samarasam I. 'Wandering spleen with acute torsion' : a rare indication for splenectomy in an adult, complicated by postoperative splanchnic venous thrombosis and intestinal gangrene. BMJ Case Rep 2021; 14:14/2/e238647. [PMID: 33541983 PMCID: PMC7868251 DOI: 10.1136/bcr-2020-238647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Wandering spleen (WS) is a hypermobile spleen that, due to the laxity of its ligaments, is prone to torsion. We report a case of a 45-year-old multiparous woman who presented with acute abdominal pain and a tender palpable mass. A contrast-enhanced computed tomography scan of the abdomen showed a WS with torsion. She underwent an emergency splenectomy and was discharged after an uneventful recovery. She was readmitted with splanchnic venous thrombosis and was managed with therapeutic low-molecular-weight heparin (LMWH) and discharged. Twenty days later, she presented with new-onset abdominal pain. She had not complied with LMWH as advised. The thrombosis had progressed, leading to small bowel gangrene, requiring resection and a stoma. Due to frequent metabolic disturbances, an early reversal of stoma was performed. She was lost to follow-up thereafter. This case highlights a rare indication for emergency splenectomy and one of its major postoperative complications.
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Affiliation(s)
- Geet Midha
- General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Suraj Surendran
- General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Myla Yacob
- General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Inian Samarasam
- General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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7
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Gulati M, Suman A, Garg A. Torsion of Wandering Spleen and its adherence to the right ovary - An unusual cause of recurrent pain abdomen. J Radiol Case Rep 2020; 14:10-18. [PMID: 33088415 DOI: 10.3941/jrcr.v14i7.3752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Wandering spleen is a rare condition in which the spleen is hypermobile due to laxity or lack of its supporting ligaments. It can be located anywhere in the abdomen besides its usual position. The other terms that are used to describe this condition are splenic ptosis, displaced spleen, dislocated spleen and ectopic spleen. Splenic torsion is a dreaded complication and the usual cause of symptoms. There is a high chance of missing the diagnosis as it remains asymptomatic or may be incidentally discovered on radio-imaging done for a different purpose. An acute abdomen is the most common presentation. Here we describe an unusual case presenting with torsion of the wandering spleen that was adherent to the right ovary.
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Affiliation(s)
- Malvika Gulati
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Abhishek Suman
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
| | - Anju Garg
- Department of Radiology, Maulana Azad Medical College, New Delhi, India
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8
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Assaf R, Shebli B, Alzahran A, Rahmeh AR, Mansour A, Hamza R, Alaasy Alkushti E, Ayoub K. Acute abdomen due to an infarction of wandering spleen: case report. J Surg Case Rep 2020; 2020:rjz378. [PMID: 32082535 PMCID: PMC7024078 DOI: 10.1093/jscr/rjz378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 11/28/2019] [Accepted: 12/01/2019] [Indexed: 12/03/2022] Open
Abstract
Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all spleen ligaments that fixate the spleen in the left upper quadrant. Many different terms refer to wandering spleen like dislocated spleen, ectopic spleen and displaced spleen. We report in this case a 13-year-old Syrian girl presented to the emergency department complaining of acute generalized abdominal pain with fever, anorexia and vomiting started 2 days prior to presentation. A splenectomy was performed, with uneventful postsurgical follow-up. Wandering spleen is prone to torsion and infarction resulting in acute abdomen and a life-threatening condition with high mortality rate reaching 50%. We advise the investigation of any recurrent episodes of chronic pain keeping up within mind this diagnosis.
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Affiliation(s)
- Ragheb Assaf
- Faculty of Medicine, Department of Pediatric Surgery, Aleppo University Hospital
| | | | | | | | | | - Rama Hamza
- Faculty of Medicine, University of Aleppo
| | | | - Kusay Ayoub
- Department of Surgery, Aleppo University Hospital
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9
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Abstract
Wandering spleen is a rare entity that results from the absence or maldevelopment of the ligaments that support the spleen in its normal location. As a result, the spleen is hypermobile and may be predisposed to hilar torsion and subsequent infarction, making it a potentially fatal abdominal emergency. We present a case of a 36-year-old Afghan female who presented with an acute abdomen, and was radiologically and surgically confirmed to have a wandering spleen with torsion and complete infarction. Knowledge of this condition and its radiological findings can play a crucial role in making a correct and timely diagnosis.
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Affiliation(s)
- Dawar B Khan
- Department of Radiology, The Aga Khan University, Karachi, PAK
| | | | | | - Sarim D Khan
- Medical College, The Aga Khan University, Karachi, PAK
| | - Rabail Raza
- Department of Radiology, The Aga Khan University, Karachi, PAK
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10
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Bayramoglu M, Haberal KM, Kahraman G, Avci T. Partial Splenic Torsion in situ: Revealed by Ultrasound and Computed Tomography. J Med Ultrasound 2018; 26:107-108. [PMID: 30065530 PMCID: PMC6029199 DOI: 10.4103/jmu.jmu_25_18] [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: 11/27/2017] [Accepted: 01/19/2018] [Indexed: 11/27/2022] Open
Abstract
We present a case of acute abdominal pain due to partial torsion of spleen located in its own normal anatomical position in a 20-year-old woman, diagnosed by ultrasound and confirmed on computed tomography and treated laparoscopically.
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Affiliation(s)
- Mert Bayramoglu
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - K Murat Haberal
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Gokhan Kahraman
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Tevfik Avci
- Department of General Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey
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11
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Chauhan NS, Kumar S. Torsion of a Wandering Spleen Presenting as Acute Abdomen. Pol J Radiol 2016; 81:110-3. [PMID: 27057261 PMCID: PMC4795092 DOI: 10.12659/pjr.895972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/02/2015] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Narvir Singh Chauhan
- Department of Radiodiagnosis, Dr. Rajendra Prasad Government Medical College, Kangra, India
| | - Satish Kumar
- Department of Surgery, Dr. Rajendra Prasad Government Medical College, Kangra, India
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12
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A Tuboovarian Abscess Associated with a Ruptured Spleen. Case Rep Emerg Med 2016; 2016:8796281. [PMID: 26904315 PMCID: PMC4745980 DOI: 10.1155/2016/8796281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/27/2015] [Indexed: 11/29/2022] Open
Abstract
We report the first case of a tuboovarian abscess complicated by a ruptured spleen. Our patient was a 27-year-old female with human immunodeficiency virus (HIV) who presented to the emergency department (ED) with complaints of urinary symptoms and diarrhea. After being diagnosed with a tuboovarian abscess (TOA), she received antibiotics and was admitted to the gynecology service. Shortly thereafter she developed hemorrhagic shock, necessitating a splenectomy and salpingooophorectomy from a ruptured spleen.
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13
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Abstract
Imaging plays a major role in the evaluation of patients who present to the emergency department with acute left upper quadrant (LUQ) pain. Multidetector computed tomography is currently the primary modality used for imaging these patients. The peritoneal reflections, subperitoneal compartment, and peritoneal spaces of the LUQ are key anatomic features in understanding the imaging appearance of acute diseases in this area. Diseases of the stomach, spleen, pancreas, and splenic flexure are encountered in patients with acute LUQ pain. Optimization of the imaging protocol is vital for accurate diagnosis and characterization of these diseases in the acute setting.
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Affiliation(s)
- Jacob S Ecanow
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Suite G507, Evanston, IL 60201, USA
| | - Richard M Gore
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Suite G507, Evanston, IL 60201, USA.
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14
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Abstract
Wandering spleen or splenoptosis is an uncommon entity and often an asymptomatic finding of acute abdomen in the emergency department. A high index of suspicion for splenic torsion is required, particularly in patients with known splenomegaly, as this condition could potentially lead to splenic infarction. Recognition of this condition can help avoid potential confusion with acute abdomen of other aetiologies. Herein, we present a unique case of wandering spleen with chronic torsion, which, to the best of our knowledge, has never been described in an elderly patient with haemoglobin H thalassaemia. We also review the literature for the aetiology and pathogenesis of wandering spleen, and discuss the relevant diagnostic modalities and treatment options.
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Affiliation(s)
- Chi Long Ho
- Department of Diagnostic Radiology, Singapore General Hospital, 4 Outram Road, Singapore 169608.
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15
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Rellum R, Risseeuw G, Blaauw ID, Lequin M. Splenorenal collaterals as hallmark for a twisted wandering spleen in a 14-year-old girl with abdominal pain: a case report. European J Pediatr Surg Rep 2014; 2:26-8. [PMID: 25755964 PMCID: PMC4336078 DOI: 10.1055/s-0034-1370776] [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: 12/15/2013] [Accepted: 12/27/2013] [Indexed: 11/15/2022] Open
Abstract
Wandering spleen is a rare cause of acute or chronic recurrent abdominal pain with a risk of splenic torsion and infarction. We describe a case of a 14-year-old girl with chronic recurrent abdominal pain with a palpable spleen in normal position on the initial physical examination. Laboratory findings were normal. A normal blood flow was seen on the initial (color Doppler) sonography. Magnetic resonance imaging showed an enlarged spleen in the pelvic region with torsion of hilar pedicle and splenorenal collaterals. Semielective, a laparoscopic splenopexy was performed without complications. A twisted wandering spleen should be included in the differential diagnosis of recurrent abdominal pain despite possible normal positioning of the spleen. The presence of splenorenal collaterals on imaging techniques can be used as a diagnostic hallmark.
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Affiliation(s)
- Rashidi Rellum
- Department of Internal Medicine, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Gerard Risseeuw
- Department of Radiology, Ruwaard van Putten Hospital, Spijkenisse, The Netherlands
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud Medical Centre, Nijmegen, The Netherlands
| | - Maarten Lequin
- Department of Radiology, Sophia Childrens Hospital, Rotterdam, The Netherlands
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16
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Abstract
Wandering spleen is a rare occurrence. Torsion of the splenic pedicle is the major life-threatening complication of this entity. Preoperative diagnosis is based on radiological investigation. We report two consecutive cases, one adult and one child, in whom torsion in a wandering spleen was diagnosed based on a typical whirled appearance of the splenic vessels on computed tomography. We present a review of computed tomographic appearance of splenic torsion, and emphasize the "whirled appearance" as a specific sign for splenic torsion in wandering spleen.
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17
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Abstract
We present the clinical and imaging findings in a patient presenting with left upper quadrant pain. On plain films, a mass was seen in the left upper quadrant, and on computed tomography (CT), a spleen with a whorled pedicle suggesting torsion was identified. However, it was the coronal reconstruction CT study that definitely showed that the spleen had undergone a 180-degree torsion. We refer to the findings on the coronal CT reconstruction as the "upside down" spleen sign, and it was very helpful in clinching the diagnosis.
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18
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Yılmaz Ö, Bayrak V, Daştan E, Kotan Ç. Torsion of wandering spleen as a rare reason for acute abdomen: A presentation of two cases. ULUSAL CERRAHI DERGISI 2013; 29:200-2. [PMID: 25931877 DOI: 10.5152/ucd.2013.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 03/04/2013] [Indexed: 11/22/2022]
Abstract
Wandering spleen is a rare disease that is clinically characterized by torsion of the pedicle. The congenital absence of ligaments anchoring the spleen to the left sub-phrenic area or an acquired looseness is the major reason behind its mobilization. Unless splenic torsion occurs and acute abdominal clinical symptomatology develops, clinical diagnosis is highly challenging due to lack of symptoms. This study aims to share the information acquired from two encountered cases accompanied by the relevant literature.
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Affiliation(s)
- Özkan Yılmaz
- Department of General Surgery, Ersin Arslan State Hospital, Gaziantep, Turkey
| | - Vedat Bayrak
- Department of General Surgery, Ceyhan State Hospital, Adana, Turkey
| | - Ertuğrul Daştan
- Department of General Surgery, Bitlis State Hospital, Bitlis, Turkey
| | - Çetin Kotan
- Department of General Surgery, Faculty of Medicine, Yüzüncü Yıl University, Van, Turkey
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19
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Lubner MG, Simard ML, Peterson CM, Bhalla S, Pickhardt PJ, Menias CO. Emergent and Nonemergent Nonbowel Torsion: Spectrum of Imaging and Clinical Findings. Radiographics 2013; 33:155-73. [DOI: 10.1148/rg.331125016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Abstract
Torsion of an accessory spleen is an uncommon cause of abdominal pain. Only a few cases have been reported in the literature. Most cases occur in children, and in most cases the diagnosis is made at surgery. We report a case of torsion of an accessory spleen in an adult female who presented with acute left-flank pain. The diagnosis was made on contrast-enhanced computed tomography (CT) and was confirmed at surgery. Without treatment, torsion of an accessory spleen can lead to hemorrhagic shock, peritonitis, and bowel obstruction. It is useful for the radiologist to make this diagnosis on imaging so that biopsy can be avoided and surgery performed to avoid complications.
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21
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Chen JW, Yeh DM, Peng SH, Chen GS, Tseng YH, Lin CW, Tyan YS, Tsao TF. Sonographic diagnosis of a subclinical wandering spleen: role of the decubitus position. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:483-487. [PMID: 22368139 DOI: 10.7863/jum.2012.31.3.483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A wandering spleen is a rare condition. It is usually diagnosed when abdominal pain develops secondary to splenic torsion. Although splenic hypermobility is the pathognomonic feature of a wandering spleen, it is rarely revealed by imaging in the subclinical stage. We report 3 patients with a subclinical wandering spleen who had incidental sonographic findings of splenomegaly. Gray scale and color Doppler sonography in the right decubitus position can easily show the migratory nature and perfusion status of a wandering spleen in real time.
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Affiliation(s)
- Jhih-Wei Chen
- Department of Medical Imaging, Chung Shan Medical UniversityHospital, Taichung, Taiwan
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22
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Saouab R, Dafiri R. Post-traumatic acute abdominal pain. Br J Radiol 2010; 83:804-6. [PMID: 20739346 PMCID: PMC3473410 DOI: 10.1259/bjr/88857252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 02/07/2010] [Accepted: 02/08/2010] [Indexed: 11/05/2022] Open
Affiliation(s)
- R Saouab
- Department of Radiology, Children's Hospital, Rabat, Morocco.
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23
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Sodhi KS, Gupta P, Rao KLN, Marwaha RK, Khandelwal N. Marfanoid hypermobility syndrome and skeletal abnormalities in a rare case of torsion of wandering spleen. Br J Radiol 2008; 81:e145-8. [PMID: 18440937 DOI: 10.1259/bjr/30123041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Wandering spleen is a rare clinical entity characterized by splenic hypermobility resulting from laxity or maldevelopment of supporting splenic ligaments. Its major complication is splenic torsion, which is a potentially fatal surgical emergency. We present a rare case of wandering spleen with torsion and splenic infarction in a patient with marfanoid hypermobility syndrome and vertebral abnormalities.
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Affiliation(s)
- K S Sodhi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh-160012, India.
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24
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Liu HTM, Lau KK. Wandering spleen: an unusual association with gastric volvulus. AJR Am J Roentgenol 2007; 188:W328-30. [PMID: 17376999 DOI: 10.2214/ajr.05.0672] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Huai-Tzu Michael Liu
- Department of Radiology, Monash Medical Center, Rm. 116, 246 Clayton Rd., Clayton South, Victoria 3168, Australia.
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25
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Soleimani M, Mehrabi A, Kashfi A, Fonouni H, Büchler MW, Kraus TW. Surgical Treatment of Patients with Wandering Spleen: Report of Six Cases with a review of the literature. Surg Today 2007; 37:261-9. [PMID: 17342372 DOI: 10.1007/s00595-006-3389-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 07/25/2006] [Indexed: 12/19/2022]
Abstract
Wandering spleen, which is defined as a spleen without peritoneal attachments, is a rare disease and a delay in the clinical and/or radiological diagnosis may lead to splenic torsion, infarction, and necrosis. Owing to the physiologic importance of the spleen, especially in children, and the risk of postsplenectomy sepsis, early diagnosis and splenopexy are recommended. In the present article, we describe the results of our management of this rare problem on six patients, and we review all available literature from 1895 to 2005. Briefly, our technique includes flap creation from parietal peritoneum and settlement of spleen in the fossa splenica. Free edges of this flap are stitched to the stomach and the left end of transverse colon and the beginning of the descending colon. The body of the stomach was stitched to the abdominal wall to prevent gastric volvulus, while the fundus region was fixed to the diaphragm to support the spleen. Finally, an omental patch was stitched to the intact abdominal wall above the flap. In conclusion, the procedure of splenopexy without using mesh is considered to be a safe and curative modality for wandering spleen without imposing any undue risk of infection or foreign material reaction.
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26
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Mendi R, Abramson LP, Pillai SB, Rigsby CK. Evolution of the CT imaging findings of accessory spleen infarction. Pediatr Radiol 2006; 36:1319-22. [PMID: 17016699 DOI: 10.1007/s00247-006-0323-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 08/18/2006] [Accepted: 08/24/2006] [Indexed: 10/24/2022]
Abstract
We report the case of a 12-year-old girl presenting with multiple episodes of left upper-quadrant pain caused by torsion of an accessory spleen.We present the CT findings of progression of accessory spleen infarction over the course of 7 days.
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Affiliation(s)
- Resham Mendi
- Department of Medical Imaging, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614, USA
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27
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Alam A, Ram MS. Torsion of Wandering Spleen: Diagnosis using Magnetic Resonance Imaging. Med J Armed Forces India 2006; 62:81-2. [PMID: 27407856 DOI: 10.1016/s0377-1237(06)80169-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 06/05/2004] [Indexed: 11/30/2022] Open
Affiliation(s)
- A Alam
- Associate Professor(Radiology), AFMC, Pune-40
| | - Mn Sree Ram
- Professor and Head (Radiology), AFMC, Pune-40
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28
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Park KS, Shin MS, Kim SY, Sul JY, Lee KS. Acute Torsion of a Wandering Spleen Managed by Splenopexy. THE KOREAN JOURNAL OF HEMATOLOGY 2005. [DOI: 10.5045/kjh.2005.40.4.278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kyoung Soo Park
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Myung Seok Shin
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Young Kim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji Young Sul
- Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Keon Su Lee
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
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29
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Deux JF, Salomon L, Barrier A, Callard P, Bazot M. Acute torsion of wandering spleen: MRI findings. AJR Am J Roentgenol 2004; 182:1607-8. [PMID: 15150027 DOI: 10.2214/ajr.182.6.1821607] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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30
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Bakir B, Poyanli A, Yekeler E, Acunas G. Acute torsion of a wandering spleen: imaging findings. ACTA ACUST UNITED AC 2004; 29:707-9. [PMID: 15185033 DOI: 10.1007/s00261-004-0174-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2003] [Accepted: 01/07/2004] [Indexed: 11/26/2022]
Abstract
Wandering spleen is a rare entity characterized by incomplete fixation of the spleen by lienorenal and gastrosplenic ligaments. It can migrate to the lower abdomen or pelvis and can be congenital or acquired. We report a case of torsion of a wandering spleen for which there was correlative imaging by ultrasonography, Doppler ultrasonography, computed tomography, magnetic resonance imaging, and angiography. To our knowledge, this is the first reported case in which all these modalities were used in the diagnostic evaluation.
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Affiliation(s)
- B Bakir
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, 34390, Capa, Istanbul, Turkey.
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31
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Abstract
Torsion of a wandering spleen is a rare cause of abdominal pain in children. The most common presentation is acute abdominal pain, although signs and symptoms vary widely. Due to the risk of splenic infarction, rapid and accurate diagnosis is essential. Wandering spleen and splenic torsion can be diagnosed by Doppler ultrasound and CT scan. Treatment options include splenopexy or splenectomy. This case describes a 9-year-old girl with torsion of a wandering spleen, complicated by splenic infarction and managed by splenectomy.
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Affiliation(s)
- Jennifer R Romero
- Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213-2583, USA
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32
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Abstract
Torsion of a wandering spleen is a rare but fulminant condition and is part of the differential diagnosis in patients presenting with acute abdominal pain. It results due to absence or laxity of the various ligaments supporting the spleen. Patients may be asymptomatic or may present with acute abdominal pain. It may occur in people of all ages, with a predilection for male patients under 10 years of age and for female patients in older age groups, being most common in multiparous women. Early intervention is necessary to reduce the risk of splenic infarction and other complications. An awareness of the condition together with use of appropriate medical imaging can lead to the correct diagnosis.
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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33
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Kessler A, Miller E, Keidar S, Blachar A, Sira LB, Weinberg M, Rachmel A. Mass at the splenic hilum: a clue to torsion of a wandering spleen located in a normal left upper quadrant position. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:527-530. [PMID: 12751865 DOI: 10.7863/jum.2003.22.5.527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Wandering spleen is an extremely rare condition in which the spleen is lacking its normal ligamentous attachments and therefore can move to an ectopic position in the abdomen or pelvis. Wandering spleen predisposes the patient to life-threatening complications due to torsion of the spleen's vascular pedicle, with resulting splenic infarction, portal hypertension, and bleeding. Because of the nonspecific symptoms, imaging plays an important role. To our knowledge, only a few case reports describing wandering spleen in the pediatric population have been published, including 2 cases in infancy. We report a case of splenic torsion in an infant with a preoperative diagnosis made on the basis of color and power Doppler sonography. The diagnosis was confirmed by contrast-enhanced helical computed tomography (CT) and proved at surgery. On sonography, a diffusely hypoechoic spleen and a mass at the splenic hilum representing the torsed splenic pedicle were shown. The splenic hilar mass correlates with the CT "whirl" sign indicative of torsion.
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Affiliation(s)
- Ada Kessler
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Avi, Israel
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34
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Affiliation(s)
- Simmi Chawla
- Department of Radiology, Penn State University, Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033-0850, USA.
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35
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d'Halluin G, Menard J, Dessard P, Dauphin H, Deshayes M, Pierre F, Magnin G. [Torsion of the accessory spleen: an atypical etiology for acute abdomen]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2001; 29:821-3. [PMID: 11770276 DOI: 10.1016/s1297-9589(01)00226-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The accessory spleen is often a incidental discovery. The accessory post-accidental spleen are unusual. The torsion of a movable spleen is possible and represent about 0.2 to 0.3% of splenectomy. But the torsion of an accessory spleen is exceptional. A case of acute torsion of an accessory spleen is reported. In a 26-year-old women was admitted with acute abdominal pain. The abdominal ultrasound and the abdominal X-Ray are no specific. In the face of the acute pain, a laparoscopy was necessary. At laparoscopy, the patient was found to have torsion and infarction of an accessory spleen in the pelvis. The treatment was a splenectomy and the evolution was favorable.
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Affiliation(s)
- G d'Halluin
- Service de gynécologie, obstétrique et biologie de la reproduction, CHU de Poitiers, rue de la Milétrie, BP 577, 86021 Poitiers, France.
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36
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Bhasin A, Gulati MS, Kashyap R. Value of power Doppler sonography in the evaluation of torsion in a wandering spleen. JOURNAL OF CLINICAL ULTRASOUND : JCU 2001; 29:60-61. [PMID: 11180188 DOI: 10.1002/1097-0096(200101)29:1<60::aid-jcu11>3.0.co;2-o] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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37
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Paterson A, Frush DP, Donnelly LF, Foss JN, O'Hara SM, Bisset GS. A pattern-oriented approach to splenic imaging in infants and children. Radiographics 1999; 19:1465-85. [PMID: 10555669 DOI: 10.1148/radiographics.19.6.g99no231465] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The spleen in infants and children is commonly involved in a variety of pathologic processes. Some of these processes cause isolated splenic disease, whereas others involve the spleen as part of a systemic illness. To facilitate differential diagnosis of splenic abnormalities, a pattern-oriented approach to the imaging evaluation of the pediatric spleen was developed. With this approach, splenic anomalies are categorized as anomalies of splenic shape (clefts, notches, lobules), location (eg, wandering spleen), number (polysplenia, asplenia), or size (splenomegaly, splenic atrophy); solitary lesions (eg, cysts, lymphangiomas, hemangiomas, hamartomas); multiple focal lesions (eg, trauma, infection and inflammation, neoplasms, storage disorders); and diffuse disease without focal lesions (eg, infarction, heavy metal deposition, hemangioendotheliomas, peliosis). A variety of imaging modalities can be used in splenic assessment, including computed tomography, magnetic resonance imaging, ultrasound, and technetium-99m scintigraphy. The imaging appearance of the pediatric spleen depends on the patient's age and the modality used; however, familiarity with the spectrum of radiologic patterns of splenic involvement will facilitate correct diagnosis and prompt treatment.
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Affiliation(s)
- A Paterson
- Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
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38
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Hirose R, Kitano S, Bando T, Ueda Y, Sato K, Yoshida T, Suenobu S, Kawano T, Izumi T. Laparoscopic splenopexy for pediatric wandering spleen. J Pediatr Surg 1998; 33:1571-3. [PMID: 9802819 DOI: 10.1016/s0022-3468(98)90503-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Wandering spleen is an uncommon condition, showing a splenic hypermobility that results from laxity or maldevelopment of its suspensory ligament. This condition results in constant danger of splenic torsion and infarction. Wandering spleen was diagnosed in a 2-year-old girl who complained of intermittent abdominal pain, and viability of the spleen was confirmed by doppler ultrasound scan. Elective laparoscopic splenopexy was performed by anchoring the spleen wrapped in absorbable mesh. To our knowledge, this is the first reported case of laparoscopic splenopexy for wandering spleen. The authors believe that this approach is a safe and effective procedure for wandering spleen with the advantage of minimally invasive surgery.
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Affiliation(s)
- R Hirose
- Department of Surgery I and Pediatrics, Oita Medical University, Japan
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39
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Abstract
A case of torsion of the wandering spleen with splenic infarction is reported. The medical imaging studies performed with typical findings are described. Case reports have been reviewed. Although rare, torsion of the spleen remains an important differential diagnosis in patients presenting with acute abdominal pain. Early intervention is necessary to reduce the risk of splenic infarction and other complications, and an increased awareness of the condition together with the use of appropriate medical imaging can lead to the correct diagnosis more readily.
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Affiliation(s)
- T Y Hon
- Department of Diagnostic Radiology and Organ Imaging, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
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40
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Saadaoui H, Toppet VM, Hubloux G, Horth M, Cadière GB, Spehl MR. Acute torsion of a wandering spleen in a child: preoperative diagnosis by ultrasonography and computed tomography. Eur J Radiol 1998; 26:205-9. [PMID: 9518230 DOI: 10.1016/s0720-048x(96)01121-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- H Saadaoui
- Department of Radiology, Hôpital Universitaire Saint-Pierre, Bruxelles, Belgium
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41
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Emery KH. SPLENIC EMERGENCIES. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00436-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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42
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Abstract
A wandering spleen is a rare condition characterized by splenic malposition due to congenital maldevelopment or laxity of the supporting ligamentous structures that usually fixate the anatomical position of the spleen. The diagnosis is often difficult to make clinically. In this report, a case is described in which an In-111 oxime labeled leukocyte scan was helpful in making a diagnosis of a wandering spleen.
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Affiliation(s)
- L F Posillico
- Department of Radiology, University of Pittsburgh Medical Center, PA 15213, USA
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43
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Affiliation(s)
- C Lopez Menendez
- Department of Radiology, Hospital Covadonga, Oviedo, Asturias, Spain
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44
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Abstract
A patient with an excessively mobile accessory spleen detected on ultrasound examination is reported in whom a normally located spleen was also found. Sonographic and colour Doppler imaging criteria were used for making the specific diagnosis. The large accessory spleen has been demonstrated at different sites within the abdomen on subsequent follow-up sonographic examinations. The splanchnic flow pattern obtained from the long vascular pedicle of the accessory spleen indicated normal perfusion. Since the perfusion of the wandering accessory spleen was not compromised by torsion, and the patient refused surgical intervention, a conservative approach was considered to be appropriate.
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Affiliation(s)
- A Erden
- Department of Radiology, Yüksek Ihtisas Hospital, Ankara, Turkey
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45
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Berkenblit RG, Mohan S, Bhatt GM, Rosenzweig M, Blitz A. Wandering spleen with torsion: appearance on CT and ultrasound. ABDOMINAL IMAGING 1994; 19:459-60. [PMID: 7950828 DOI: 10.1007/bf00206940] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Wandering spleen is a rare entity which may present with symptoms suggestive of other, more common abdominal processes. Torsion of the long pedicle may occur causing abdominal pain. This article describes a case of wandering spleen diagnosed by computed tomography (CT). Liver spleen scintigraphy and sonography supported this diagnosis and suggested torsion. To our knowledge this is only the second case of this entity in which color flow and duplex Doppler findings have been reported.
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Affiliation(s)
- R G Berkenblit
- Department of Radiology, Montefiore Medical Center, Bronx, NY 10467
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46
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Newman B, Bowen A, Eggli KD. Recognition of malposition of the liver and spleen: CT, MRI, nuclear scan and fluoroscopic imaging. Pediatr Radiol 1994; 24:274-9. [PMID: 7800451 DOI: 10.1007/bf02015456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Thirteen children initially suspected to have an intrathoracic or intraabdominal mass had malposition of the liver and/or spleen discovered by ultrasound. This group consisted of five children with diaphragmatic eventration or hernia and eight with wandering spleen or liver. Careful ultrasonographic examinations were diagnostic in all patients; seven had surgical confirmation. CT, MRI, nuclear scan and fluoroscopic imaging were useful in select instances. The liver and spleen have a characteristic anatomic configuration and sonographic appearance that should enable them to be recognized, and pathological alterations appreciated, even when these organs are ectopic in location or malformed.
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Affiliation(s)
- B Newman
- Department of Radiology, University of Pittsburgh School of Medicine, PA
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47
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Abstract
Gastric volvulus and wandering spleen are related to anomalies in the intraperitoneal visceral attachments. When encountered during infancy, they have a congenital origin with acquired predisposing factors. Wandering spleen is a rare clinical entity with a diverse form of presentation. To our knowledge, gastric volvulus associated with wandering spleen has not been reported previously in literature.
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Affiliation(s)
- J A Garcia
- Department of Diagnostic Radiology, Carlos Haya General Hospital, Malaga, Spain
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48
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Swischuk LE, Williams JB, John SD. Torsion of wandering spleen: the whorled appearance of the splenic pedicle on CT. Pediatr Radiol 1993; 23:476-7. [PMID: 8255657 DOI: 10.1007/bf02012458] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Congenital deficiency or acquired laxity of the suspensory ligaments of the spleen may result in extreme splenic mobility. This rare condition, which is termed wandering or ectopic spleen predisposes the elongated splenic pedicle to torsion. We present a case of splenic torsion with a new CT finding consisting of a whorled appearance of the splenic pedicle. To our knowledge this finding has not been described before.
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Affiliation(s)
- L E Swischuk
- Department of Radiology, Children's Hospital C-65, University of Texas Medical Branch, Galveston 77555
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