Abstract
Background: Wandering spleen (WS) is an uncommon splenic disorder defined as the displacement of the spleen from its usual anatomical position. It is most prevalent in females in their reproductive age. It can be encountered incidentally or may present with symptoms. Risks of complications exist and vary with the presentation. Several imaging techniques are able to define it clearly preoperatively. Laparoscopic surgery is the definitive diagnostic and therapeutic method. Case Report: A 24-year-old pregnant female patient presented to the Emergency Department complaining of intermittent dull abdominal pain and pelvic heaviness for 9 days. Contrast- Enhanced Computed Tomography and a color Doppler sonography of the abdomen and pelvis showed a large-sized spleen in the pelvis corresponding to a diagnosis of WS, without ischemic signs. The patient underwent a laparoscopic splenectomy and was vaccinated for Haemophilus influenza, meningococcus, and pneumococcus postoperatively. The post-operative period was uneventful, and the patient later delivered a full-term baby girl by a Cesarean section. Conclusion: This is, to the best of our knowledge, the second reported case of laparoscopic splenectomy in a pregnant patient with WS. While splenopexy is associated with better outcomes, splenectomy seems to be preferred in pregnant patients, who may undergo a vaginal delivery, but guidelines and data are still scarce regarding the management of WS in pregnancy. Vaccination against encapsulated bacteria is required in case of splenectomy
Highlights
ConclusionThis is, to the best of our knowledge, the second reported case of laparoscopic splenectomy in a pregnant patient with Wandering spleen (WS)
Wandering spleen (WS) is an uncommon splenic disorder defined as the displacement of the spleen from its usual anatomical position
While splenopexy is associated with better outcomes, splenectomy seems to be preferred in pregnant patients, who may undergo a vaginal delivery, but guidelines and data are still scarce regarding the management of WS in pregnancy
Summary
This is the second case of a WS treated with laparoscopic splenectomy in a pregnant woman reported in English literature. WS is not a daily encountered diagnosis. A high level of suspicion is required during the physical examination of such cases, and preoperative imaging diagnosis is essential, especially to assess vascular suffering before the planned procedure. Splenopexy is superior to splenectomy, but data and guidelines are lacking in the case of a pregnant patient. Triple vaccination against encapsulated bacteria must be performed when opting for a splenectomy
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