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Rasheed O, Wassouf A, Abo Al Shamat A, Daoud R, Knaj D, Ahmad G. Wandering spleen in a postpartum female: a case report. Ann Med Surg (Lond) 2024; 86:3099-3102. [PMID: 38694347 PMCID: PMC11060191 DOI: 10.1097/ms9.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/04/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction and importance Wandering spleen (WS) is a rare condition that occurs when the spleen is not in its normal anatomical location, but in the abdominal or pelvic cavity. The mechanism of this condition may be due to dysfunction of ligaments that fixate the spleen in its position. Female hormonal alterations during pregnancy and other unknown causes in children may also play role in an ectopic spleen. Case presentation The authors report a case of a 34-year-old woman who presented to the emergency department with intermittent abdominal pain that persisted after childbirth without other symptoms. Clinical discussion Clinically the symptoms are varied and abdominal pain is the most common presentation. Radiological investigation of WS include ultrasound, MRI, and CT, which is the most preferred tool. Treatments after the diagnosis include splenectomy or splenopexy either through laparoscopy or laparotomy. Conclusion Physicians should include ectopic spleen as a differential diagnosis in a multiparous woman with the presentation of acute or chronic abdominal pain.
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Affiliation(s)
| | | | - Aiman Abo Al Shamat
- Faculty of Medicine, Al Andalus University for Medical Sciences, Qadmus, Tartus, Syrian Arab Republic
| | | | - Duaa Knaj
- PhD student, Faculty of Medicine, Tishreen University, Lattakia
| | - Ghanem Ahmad
- Professor of Vascular Surgery, Tishreen University, Faculty of Medicine
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2
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Eleiwi M, Atatri Y, Younis O, Zuhd J, Awadghanem A, Qashoo A, Sholi S, Bustame S. Wandering Spleen Torsion: A Diagnostic Challenge. Cureus 2024; 16:e53552. [PMID: 38445142 PMCID: PMC10913703 DOI: 10.7759/cureus.53552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
Wandering spleen, or hypermobile spleen, arises from the elongation or maldevelopment of the spleen's suspensory ligaments. This condition is a rare clinical entity, primarily affecting children, with a higher prevalence among adult females in the active reproductive age group. Manifestations may include an asymptomatic abdominal mass or intermittent abdominal discomfort due to the torsion and subsequent spontaneous detorsion of the spleen. This case report details the presentation of a 14-year-old female initially misdiagnosed as having gastroenteritis who later experienced acute abdomen. Subsequent ultrasonography and computed tomography scan revealed splenic torsion, confirmed during exploratory laparotomy, which demonstrated an infarcted spleen. The definitive therapeutic intervention was a total splenectomy. This clinical entity should be taken into account in the differential diagnosis of acute abdominal pain in order to aid in early diagnosis and management. This could allow us to avoid splenectomy whenever possible and instead do splenopexy, especially in pediatric cases, as the spleen plays a crucial role in the reticuloendothelial system.
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Affiliation(s)
- Malak Eleiwi
- Medicine, An-Najah National University Hospital, Nablus, PSE
| | - Yazid Atatri
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Omar Younis
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Jehad Zuhd
- Anesthesia, An-Najah National University Hospital, Nablus, PSE
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Ahmed Awadghanem
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
| | - Ahmad Qashoo
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Suha Sholi
- General Surgery, An-Najah National University Hospital, Nablus, PSE
| | - Samer Bustame
- Pediatric Surgery, An-Najah National University Hospital, Nablus, PSE
- Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, PSE
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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Cetinoglu YK, Karasu S, Acar T, Uluc ME, Haciyanli M, Tosun O. Torsion of Wandering Spleen: Importance of Splenic Density and Liver-to- Spleen Attenuation Ratio on CT. Curr Med Imaging 2020; 16:88-93. [PMID: 31989898 DOI: 10.2174/1573405614666181009142322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 08/19/2018] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Wandering spleen (WS) is a rare clinical condition which may cause fatal complication like torsion with subsequent infarction. Determination of splenic parenchyma viability is very important in deciding whether splenopexy rather than splenectomy is an option. Contrast- enhanced computed tomography (CECT) is important for the diagnosis of WS and assessment of the viability of spleen. DISCUSSION We reviewed the CT studies of four cases with WS. We measured the mean splenic and liver density and calculated liver-to-spleen attenuation ratio (LSAR). We also assessed the CT findings for each patient. Mean splenic density was measured as 40.77 Hounsfield Unit (HU) in cases with infarction, 127.1 HU in case without infarction. LSAR was calculated as 2.55 in cases with infarction, 0.99 in case without infarction. We detected whirlpool sign, intraperitoneal free fluid, splenic arterial enhancement in all patient, parenchymal and splenic vein enhancement in one patient without infarction, fat rim sign in three patients with infarction, capsular rim sign in one patient with infarction. CONCLUSION CECT should be obtained for the diagnosis of WS and assessment of the viability of spleen. CECT could suggest the diagnosis of infarction of the spleen with following findings; absence of parenchymal enhancement, very low density of spleen (<45 HU), and LSAR which is greater than 2.
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Affiliation(s)
- Yusuf Kenan Cetinoglu
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Sebnem Karasu
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Turan Acar
- Department of General Surgery, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Muhsin Engin Uluc
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Mehmet Haciyanli
- Department of General Surgery, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
| | - Ozgur Tosun
- Department of Radiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Karabaglar, Izmir, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dossouvi T, N'Timon B, Adabra K, Dagbe M, Botcho G, Leyman P, Dosseh D. [Torsion of wandering spleen: a case report in the Kara University Hospital (Togo)]. Mali Med 2016; 31:48-51. [PMID: 30079655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Wandering spleen is a rare pathology. Spleen infarction which results from the torsion of the pedicle is its main complication. We report a case of torsion of a wandering spleen diagnosed by computed tomography. The therapeutic sanction was a splenectomy because of the infarction. Nowadays, splenopexy is the best treatment if the diagnosis is done early.
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Affiliation(s)
- Tamegnon Dossouvi
- Centre Hospitalier Universitaire de Kara(Togo), service de chirurgie générale
| | - Bidamin N'Timon
- Centre Hospitalier Universitaire de Kara(Togo), service de chirurgie générale
| | - Komlan Adabra
- Centre Hospitalier Universitaire Sylvanus Olympio de Lomé (Togo)
| | - Massaga Dagbe
- Centre Hospitalier Universitaire de Kara(Togo), service de chirurgie générale
| | - Gnimdou Botcho
- Centre Hospitalier Universitaire de Kara(Togo), service de chirurgie générale
| | - Paul Leyman
- Hôpital Mère et Enfants, SOS Villages d'Enfants, Kara (Togo)
- GZA Hôpitaux - Campus St. Augustinus, Anvers (Belgique)
| | - David Dosseh
- Centre Hospitalier Universitaire Sylvanus Olympio de Lomé (Togo)
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9
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Abstract
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.
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Affiliation(s)
- James K Clark
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
| | - John Gorman
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Mike H Lee
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Brian C Barbick
- Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Robert M Marks
- Department of Radiology, Naval Medical Center San Diego, San Diego, CA, USA
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10
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Bouassida M, Sassi S, Chtourou MF, Bennani N, Baccari S, Chebbi F, Benali M, Mighri MM, Touinsi H, Sassi S. A wandering spleen presenting as a hypogastric mass: case report. Pan Afr Med J 2012; 11:31. [PMID: 22514765 PMCID: PMC3325069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 02/14/2012] [Indexed: 11/02/2022] Open
Abstract
Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all of the ligaments that hold the spleen in its normal position in the left upper quadrant of the abdomen. It is an uncommon clinical entity that mainly affects children. Among adults it most frequently affects women of reproductive age, in whom acquired laxity of the splenic ligaments is usually the cause. Patients with a wandering spleen may be asymptomatic, present with a movable mass in the abdomen, or have chronic or intermittent abdominal pain because of partial torsion and spontaneous detorsion of the spleen. A 26-year-old woman was admitted to our hospital with vomiting and abdominal pain. Abdominal examination revealed a large ovoid hypogastric mass. A CT scan showed a wandering spleen in the hypogastric region. Exploratory laparotomy revealed an ischemic spleen. A total splenectomy was performed.
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Affiliation(s)
- Mahdi Bouassida
- Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia,Corresponding author: Mahdi Bouassida, Department of surgery, Mohamed Thahar Maamouri Hospital, 8000 Mrazga, Nabeul, Tunisia
| | - Selim Sassi
- Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | | | - Noomen Bennani
- Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | - Sonia Baccari
- Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | - Fathi Chebbi
- Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | - Mechaal Benali
- Department of reanimation, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | | | - Hassen Touinsi
- Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
| | - Sadok Sassi
- Department of surgery, Mohamed Thahar Maamouri Hospital, Nabeul, Tunisia
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Abstract
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.
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Affiliation(s)
| | - Jihane Lamrani
- Department of Digestive Surgery, University Hospital Hassan II Fes, Morocco
| | - Abdellatif Louchi
- Department of Digestive Surgery, University Hospital Hassan II Fes, Morocco
| | - Mounia El Yousfi
- Department of Gastroenterology, University Hospital Hassan II Fes, Morocco
| | - Noureddine Aqodad
- Department of Gastroenterology, University Hospital Hassan II Fes, Morocco
| | - Adil Ibrahimi
- Department of Gastroenterology, University Hospital Hassan II Fes, Morocco
| | - Meriem Boubou
- Department of Medical Imaging, University Hospital Hassan II Fes, Morocco
| | - Imane Kamaoui
- Department of Medical Imaging, University Hospital Hassan II Fes, Morocco
| | - Siham Tizniti
- Department of Medical Imaging, University Hospital Hassan II Fes, Morocco
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Palanivelu C, Rangarajan M, Senthilkumar R, Parthasarathi R, Kavalakat AJ. Laparoscopic mesh splenopexy (sandwich technique) for wandering spleen. JSLS 2007; 11:246-51. [PMID: 17761090 PMCID: PMC3015717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Wandering spleen is a rare clinical condition caused by incomplete fusion of the 4 primary splenic ligaments, allowing the spleen to be mobile within the abdomen, predisposing to splenic torsion along the vascular pedicle leading to splenomegaly and infarction, often diagnosed in an emergency setting. METHODS The wandering spleen diagnosis was achieved by ultrasound in our case. We successfully treated the patient with laparoscopic splenopexy because the size was almost normal, and no infarction or evidence of hypersplenism was present. We used the sandwich technique in which 2 meshes sandwich the spleen. RESULTS This technique was found to be highly satisfactory as a treatment for wandering spleen. The patient was discharged on the third postoperative day with no intraoperative or postoperative complications. CONCLUSION Laparoscopy usually confirms the diagnosis. Recommended surgical procedures are splenopexy or splenectomy. Splenopexy is feasible, less invasive, and does not diminish splenic function.
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