Splenic Pedicle Research Articles

Wandering Spleen with Tortion – A Case Report

A 16-year-old male presented with abdominal pain over 12 months, that had acutely worsened over the 5 days pre-presentation. Preliminary outpatient investigations revealed thrombocytopaenia 90(platelets per microliter), and a pelvic spleen on abdominal ultrasound. Contrast enhanced CT of the abdomen and pelvis in the portal venous phase confirmed a pelvic spleen with torsion of the splenic hilum. The spleen appeared hypoechoic on ultrasound. On CT, the spleen had heterogeneous enhancement with some irregularly shaped regions of hypoenhancement. There was a swirl (at least two complete turns) in the splenic vascular pedicle in the left abdomen. The splenic artery demonstrated some enhancement, but no enhancement of the splenic vein. The pancreatic tail was also involved in the torted vascular pedicle. No pancreatic duct dilation, and no infarct of pancreatic parenchyma were found. A small amount of free fluid around the spleen was found with no free gas. The portal vein enhanced normally. Lack of convincing enhancement of the splenic vein and heterogenous appearance of the spleen were suspicious for early splenic ischaemia. Laparotomy revealed an engorged twisted spleen around its pedicles. The spleen was identified in the pelvis with a torted vascular pedicle, which was subsequently detorted and manipulated back into the left upper quadrant (LUQ), with a pre-peritoneal space formed in the LUQ, the spleen was inserted into this pocket.

A case report on wandering spleen; splenic pedicle torsion with infarction in a patient with AD-PCKD

A case report on wandering spleen; splenic pedicle torsion with infarction in a patient with AD-PCKD

Case Report: Severe intermittent acute abdominal pain caused by extremely rare case of lienorenal accessory spleen torsion and detorsion: an accurate diagnostic and treatment strategy

Background: Accessory spleen (AS) is a rare condition that usually does not cause any symptoms. However recurrent torsion and detorsion of AS commonly happen in the case of AS with long pedicles. Thus diagnostic and treatment procedure is needed to prevent further complication in this case. Case presentation: An extreme case of an Austronesian 22-year-old college student who presented clinical symptoms of crampy abdominal pain in the left upper quadrant (LUQ) three days before being administered in a hospital. The pain was periodically worsened and relieved for the past year due to recurrent torsion and detorsion of the accessory spleen. Radiologic findings were accessory spleen located in the lienorenalis region with the size of 1.6 x 1.8 x 1.4 cm and the vascular accessory spleen extends from the splenic pedicle to the left splenorenal region. The intraoperative finding was a blackish-brown mass with spongy consistency with 0.5 cm of the pedicle. Conclusion: A combination of USG and CT scan with arterial and venous phase is preferred to diagnose the accessory spleen early. While the findings of the accessory spleen with long pedicle are highly suggested to be treated using modified anti-Trendelenburg 3-port laparoscopic excision of the accessory spleen (LEAS).

Splenetic Torsion on Ectopic Spleen: A Case Report

Splenic volvulus, a rare torsion of the spleen around its vascular axis, can lead to severe tissue necrosis without prompt treatment. Underlying anatomical factors such as elongation of the splenic pedicle and ligament laxity increase the risk of torsion. Diagnosis is often made during emergency surgical intervention due to the rarity of the condition and the lack of specificity of symptoms. A 30-year-old woman presented with acute abdominal symptoms accompanied by fever, leading to emergency laparotomy revealing splenic volvulus. Imaging, particularly computed tomography, plays a crucial role in diagnosis. Treatment typically involves splenectomy in cases of necrosis. Wandering spleen, usually caused by ligament hyperlaxity, is a rare but important entity to recognize, often requiring surgical intervention to prevent serious complications.

Ectopic Spleen with Segmental Portal Hypertension, About a Case

Ectopic spleen is a condition in which the spleen does not sit in the left hypochondrium but has an atypical, often pelvic, location. We report the case of a 35-year-old patient suffering from chronic abdominal pain for 11 years associated with an episode of hematemesis, pollakiuria and dysuria, with anemia and notion of multiple transfusions. Abdominal ultrasound found an ectopic spleen in the pelvic position, enlarged in size, with multiple collateral venous circulations and extensive partial thrombosis of the splenic vein. A total splenectomy by midline laparotomy was performed. Perioperative exploration found a bulky pelvic spleen with a long and tortuous splenic pedicle, involuted in 3 turns without splenic infarction. When the splenic artery is clamped, the colonic and gastric varicose veins lose half their diameter, so the decision is made to perform total splenectomy. Post-splenectomy antibiotic prophylaxis and vaccination was administered. The follow-up was favorable, with a follow-up of 4 years. The patient was then lost sight of.

Safe Stapleless Laparoscopic Splenectomy; Use Of Hem-O-Lok To Control The Splenic Hilum.

To evaluate Hem-o-Lok polymer clips' feasibility, safety and cost-effectiveness in controlling the splenic pedicle during paediatric laparoscopic splenectomy. The prospective study was conducted from May 2019 to December 2021 at Kafrelsheikh University Hospital, Egypt, and comprised children of either gender aged <18 years who had benign haematological diseases and were indicated for laparoscopic splenectomy. During the procedure, Hem-o-Lok clips were used for controlling the splenic pedicle. Patients were encouraged to ambulate the same day, and the drain was removed 24hours postoperatively. The cases were followed up for three months postoperatively. Of the 23 subjects, 11(47.8%) were boys and 12(52.2%) were girls. The overall mean age was 8.74±3.44 years (range: 4-15 years). There were 6(26%) cases of spherocytosis, 1(4.3%) immune thrombocytopenic purpura and 16(69.6%) with thalassemia major. The mean operative time was 93.43±29.87 minutes(range: 65-180 minutes). There was no conversion to open splenectomy and no mortality. There were 2(8.7%) cases of minor and 1(4.3%) of major intraoperative bleeding. All the 3(100%) cases were controlled laparoscopically. No postoperative bleeding occurred and no cases required postoperative blood transfusion. Controlling both the splenic artery and vein using Hem-o-Lok clips was found to be feasible, safe and cost-effective.

Evaluation of Hem-o-lok clips in controlling the splenic pedicle in laparoscopic splenectomy in children

BackgroundSplenectomy is an established therapeutic intervention for benign haematological disorders (BHD) in children. Laparoscopic splenectomy (LS) has become accepted as the preferred alternative to the open procedure. The aim of this study was to evaluate the Hem-o-lok clips in controlling the splenic hilum during laparoscopic splenectomy in children as regards feasibility, safety, operative time, cost, and perioperative complications.MethodsThis study included 27 cases with BHD, from April 2020 to December 2021, who underwent LS. In all patients, the Hem-o-lok clips were used to control the splenic pedicle. Operative time, intraoperative complications, need for conversion, and splenic extraction were reported. Postoperative course, complications, and hospital stay were also recorded. Patients were followed up for 3 months for development of complications and for evaluation of cosmetic appearance.ResultsThe mean operative time, excluding splenic extraction, was 67.04 min. There were 3 intraoperative minor bleeding incidents, all not related to Hem-o-lok application, and they were successfully controlled, with no need for conversion. The mean hospital stay was 1.3 days. We used one cartridge for each case (cost; 686 LE, US $28).ConclusionsThe Hem-o-lok clips are feasible, safe, and cost effective in controlling the splenic hilum during LS in children with benign haematological diseases.

Anatomía de la arteria esplénica

Due to the importance and permanent iniprovementsas regards the treatmerit of different diseases involving abdominal urgans such as the abdonien, pailcreas and spleen. 1 was indined tu investigate, both from the anatonhje and surgical point ul view. une of the collateral arterial branches of the ccl iac trunk, which is possibly considered to be one the Ieast siudied and, historically one of the most torgotten by the vessels irrigating the liver and stoniLlch.Considering the fact that anatomic understanding is the startíng point of medical knowledge. and that its conquests give it perrnanently new fundamnents, 1 was deterinined to do research, intensely aixl thoruughly un splenic artery.This research work relates in detail, on the corresponcling chapters, the material and niethods used, which consist un human hodies and fietus tixed with 6.rmo1 and in a fresh condition. These human bodies and foestus were subnimtted tu disseetiun techniques of mnter-arterial injection with resmn, and then they were corroded with acid and angiographic studies. Fmnally selective artermographic tesis 'ere perlbmed un living beings by nieans of digitalis reinoval of the splenic artery.The following chapter deals with the results ubtained froni saied research work, showing that the splenic artery ormgmnates, in mill cases, from the celiac trunk, and this artery is the most iniportant with an average length uf 10.6 centimeters and of 2.3 flexuosities in all.This chapter also enumnerates the relatmonships exmsting betwecn the splenic artery and neighboring organs, the homonymnous vein, itscollateral and terminal branches which mu the hundred percent of cases showed une superior and une inferior, tu inimnedimitely subdivide mudifferent ones at the level of the splenic pedide.The collateral branches 6und were the fol lowing:- arterial pancreatic branches found in the 73 % of the cases with an average of 1 arteries in al].- posterior esophaguscardiotuberosity artery appearing in a 33% of the cases.- superior polar artery appearing in a 53% of the cases.- inferior polar artery appcaring mmm a 33% of the cases.- the short vessels appeared in the 100% of the cases, froni vich in a 73% were superior short vessels and in the remainmng 27% inferior short vessels.- the left gastruepiploon artery appeared in al the cases considered. 1 have discussed the anatomic inmportance of the splenic artery and gland with their niultiple variations and relationships. 1 have mIso considered the splenic pedicle, depending un the rear lixatmon which has the extremity of the pancreas and the splenic hillum of 2.2 ccntimeters, with final figures ranging frorn O to 4 centimeters. 1 have misometmoned the appcaramice of a 10' of super nunierary spleems. Fuially in our experience with splenic segnientatiun and with cormosionpharmaceut ical preparati un and artermograph mc studics as the baste mngredients, wc have found that in a 62.5% they have two segments. ¡ti a17% they have three segments, in a 12.5% llicy have l'our segmenis. m a 12.5 % they have tur segmcnts and in ami S% they have five segnienisin mli, in ihese cases generally dite to the high iniportance of'the polar artens. Likewise. it i s Li circulation is terminal and that spleen divistummnto segrnents is separated by non-vascular 1 evel s

Wandering Spleen: A Rare Condition with Splenic Torsion and Infarction in an Elderly Patient

Ectopic spleen or wandering spleen is an uncommon presentation in which the spleen's anatomical location is different from its fixed position in the left upper quadrant of the abdomen, due to the absence of the typical peritoneal attachments; the spleen is more mobile inside the abdomen. Congenital or acquired conditions are the cause of this anomaly, which could ultimately result in torsion and splenic infarction. Less than 0.2% of wandering spleen cases are reported annually, making it a rare clinical manifestation. Splenic vascular pedicle torsion can result in complications that can cause symptoms of an acute abdomen as a result of ischemic necrosis of the spleen. Computed tomography and ultrasonography with Doppler or CEUS are essential for accurate diagnosis due to the vague clinical signs and potential complications. This case involves a 70-year-old elderly woman who complained of extreme abdominal pain and vomiting for three days. On physical examination, a tense right lower quadrant lump was palpated, when she visited the emergency room. An urgent CT scan was done for the acute abdomen which revealed torsion of the splenic pedicle in a wandering spleen.

A case report of wandering spleen with pedicle torsion and splenic infarction being misdiagnosed as organ inversion complicated with acute appendicitis

Wandering spleen is a rare disease that is easily misdiagnosed. When combined with splenic pedicle torsion and even splenic infarction, wandering spleen is a rare and critical cause of surgical acute abdomen. We report an 18-year-old male patient with abdominal organ inversion diagnosed as acute appendicitis before operation. Laparoscopic exploration confirmed wandering spleen with splenic pedicle torsion led to splenic infarction and was complicated by appendicitis. He was treated with laparoscopic appendectomy and abdominal splenectomy. The patient recovered well after the operation and was discharged from the hospital in 7 days. During the 4-year follow-up, there was no report of complicated infections such as pneumonia or sepsis.

Postoperative Outcomes Following a Modified Method of Surgical Division of the Splenic Pedicle in 719 Patients During Splenectomy for Portal Hypertension: A 12-Year, Retrospective, Single-Center Study.

BackgroundPortal hypertension associated with liver cirrhosis can be treated by splenectomy. During splenectomy, the gastrosplenic and the splenorenal ligaments that form the hilar splenic pedicle can be surgically divided by several approaches, with the aim to reduce portal vein thrombosis (PVT) and postoperative pancreatic fistula (PPF). This 12-year retrospective study from a single center aimed to evaluate postoperative outcomes following use of a modified method of surgical division of the splenic pedicle (MSDSP) in 719 patients who underwent splenectomy for portal hypertension (PH).Material/MethodsFrom January 2010 to December 2021, 719 consecutive cirrhotic patients with PH and splenomegaly underwent splenectomy in our department. According to different methods of surgical division of the splenic pedicle, patients were divided into a Control Group (n=349) and a Study Group (n=370). The characteristics of the patients, perioperative indicators, postoperative complications (PVT, PPF and abdominal hemorrhage) and follow-up data were compared between the 2 groups. Propensity score matching was conducted to adjust for differences in preoperative characteristics at a 1: 1 ratio, resulting in 260 patients in each group.ResultsAfter PSM was conducted, intraoperative blood loss, PVT, PPF, and hospital stay were decreased significantly in the matched Study Group (all P<0.01). Both groups showed similar results concerning recurrent esophagogastric variceal bleeding and overall survival during the follow-up period.ConclusionsOur MSDSP help to reduce postoperative complications and shorten hospital stay.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

English

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.

Wandering splenomegaly reduction after splenopexy.

Introduction and importanceA wandering spleen is characterized by excessive splenic mobility due to the laxity of its ligaments, which leads to spleen migration and its long mobile vascular pedicle is liable to torsion. The purpose of this paper was to present a wandering splenomegaly reduction after splenic detorsion and splenopexy.Case presentationA 14-year-old boy presented a symptomatic visible pelvic wandering splenomegaly with torsion of the splenic pedicle. He was submitted to laparotomy, detorsion of the spleen, and splenopexy to the left diaphragm and surrounded peritoneum. The patient had an uneventful follow-up and was discharged from the hospital on the second postoperative day. All laboratory exams went to normal. The size of the spleen reduced from the 22 × 16 × 13 cm before the treatment to 14 × 12 × 10 cm after the surgical procedure.Clinical discussionThe most relevant aspect of this communication is the reduction of the huge splenomegaly to a normal size spleen after detorsion of the splenic vessels and splenopexy to the left diaphragm. Reduction of the splenic size is well-known after distal splenorenal shunt, but this is the first publication of a spontaneous splenic size reduction after treating a congestive wandering splenomegaly by detorsion of the spleen pedicle.ConclusionEctopic congestive splenomegaly due to the splenic pedicle rotation is adequately treated by splenic detorsion and splenopexy in its proper subdiaphragmatic site, which reduces the splenic size to normal.

Torsion of spleen and portal hypertension: Pathophysiology and clinical implications.

The displacement of spleen from its normal location to other places is known as wandering spleen (WS) and is a rare disease. The repeated torsion of WS is due to the presence of long pedicle and absence/laxity of anchoring ligaments. A WS is an extremely rare cause of left-sided portal hypertension (PHT) and severe gastric variceal bleeding. Left-sided PHT usually occurs as a result of splenic vein occlusion caused by splenic torsion, extrinsic compression of the splenic pedicle by enlarged spleen, and splenic vein thrombosis. There is a paucity of data on WS-related PHT, and these data are mostly in the form of case reports. In this review, we have analyzed the data of 20 reported cases of WS-related PHT. The mechanisms of pathogenesis, clinico-demographic profile, and clinical implications are described in this article. The majority of patients were diagnosed in the second to third decade of life (mean age: 26 years), with a strong female preponderance (M:F = 1:9). Eleven of the 20 WS patients with left-sided PHT presented with abdominal pain and mass. In 6 of the 11 patients, varices were detected incidentally on preoperative imaging studies or discovered intraoperatively. Therefore, pre-operative search for varices is required in patients with splenic torsion.

Ultrasonographic and CT diagnosis of a complete splenic duplication with right splenic torsion and presumed regional splenic vein hypertension in a dog.

An 8‐year‐old mixed breed dog, was referred for lethargy, abdominal discomfort, hematemesis, and melena. Abdominal ultrasound revealed mineralization of the “right splenic vein” with collateral spiraling and a suspected splenic duplication. Computed tomography confirmed the duplication along with torsion of the splenic pedicle. Exploratory laparotomy confirmed the splenic torsion associated with congestion of the gastrointestinal vessels, indicative of a chronic onset of secondary regional splenic vein hypertension.

An Unexpected Acute Abdomen Case: Torsion of a Wandering Spleen Treated with Splenopexy

Wandering spleen is a rare condition that results from the absence or looseness of the hanging ligaments that keep the spleen in its normal anatomical location. It can lead to acute abdomen with torsion and infarction of the splenic pedicle. In this article, we present a patient who came to the hospital with a grievance of severe abdominal pain and was diagnosed with a torsion of wandering spleen. The patient was treated with splenopexy. Although it is a rare case, wandering spleen should also be think of in the differential diagnosis of acute abdomen.

The usefulness of modified splenic hilum hanging maneuver in laparoscopic splenectomy, especially for patients with huge spleen: a case-control study with propensity score matching.

Although Laparoscopic splenectomy (LS) have been proven to the standard operation for removal of spleen, the rate of conversion to open surgery is still higher than those of other laparoscopic surgeries, especially for huge spleen. In order to reduce the rate of conversion to open surgery, we had developed LS using modified splenic hilum hanging (MSHH) maneuver: the splenic pedicle was transected en bloc using a surgical stapler after hanging splenic hilum with an atraumatic penrose drain tube. Between January 2005 and December 2019, we retrospectively assessed 94 patients who underwent LS. MSHH maneuver was performed in 37 patients (39.4%). We compared the intra- and postoperative outcomes between patients with or without MSHH maneuver. To adjust for differences in preoperative characteristics and blood examination, propensity score matching was used at a 1:1 ratio, resulting in a comparison of 29 patients per group. Predictive factors of conversion from LS to open surgery were elucidated using the uni- and multi-variate analyses. After the propensity score matching, blood loss (268ml vs. 50ml), the rate of conversion to open surgery (27.6% vs. 0%), and postoperative hospital stays (15days vs. 10days) were significantly decreased in patients with MSHH maneuver, respectively. Among 94 patients, 19 patients (20.2%) underwent conversion to open surgery. In multivariate analysis, spleen volume (SV) and LS without MSHH maneuver were independent predictive factors of conversion to open surgery, respectively. Additionally, cut-off value of SV for conversion to open surgery was 802ml (sensitivity: 0.684, specificity: 0.827, p < 0.001). LS using MSHH maneuver seems to be useful surgical technique to improve intraoperative outcomes and reduce the rate of conversion from LS to open surgery resulting in shorten postoperative hospital stay.

Acute splenic pedicle torsion involving pancreatic tail: case report and computed tomography diagnostic role

Background: Wandering spleen is an unusual condition characterized by hypermobility of the spleen. Excessive mobility can cause torsion of the vascular pedicle with subsequent complications such as ischemia and necrosis. Clinical manifestations can vary from asymptomatic to abdominal emergency and treatment is often surgical. Case Presentation: We presented a case report of splenic torsion in a 24-year-old woman with complaints of upper abdominal pain associated with mild left hypochondrial tenderness. Laboratory testing and ultrasound were completely negative making the diagnosis difficult. A computed tomography (CT) scan was carried out due to worsening symptoms and it demonstrated a splenic torsion with involvement of the distal part of the pancreatic tail. Surgery was performed by laparoscopic splenectomy. No signs of pancreatitis were found. Conclusion: Splenic torsion is a rare but important differential diagnosis in patients with an acute abdomen and CT is often necessary to achieve the correct diagnosis and exclude possible complications.

S1842 Splenic Laceration: A Life-Threatening Colonoscopy Complication

INTRODUCTION: Splenic laceration is a rare but potentially fatal complication of an otherwise safe and effective procedure in colonoscopy. The most commonly associated complications of the procedure include hemorrhage (1.8-2.5%) and perforation (0.34-2.14%). Patient risk factors for splenic laceration include adhesions, female sex, and anticoagulation. Procedural risk factors include hooking of the splenic flexure, alpha maneuver, and application of pressure at the left hypochondrium. Here, we present the case of a 59-year-old male on dual anti-platelet therapy who underwent colonoscopy complicated by splenic laceration. CASE DESCRIPTION/METHODS: A 59-year-old male with recent history of colonoscopic adenomatous polypectomy underwent follow-up colonoscopy with subsequent development of post-operative hemodynamic instability. Medical history was significant for MI status-post cardiac catheterization with 2 stents to RCA on dual anti-platelet therapy, held for 7 days prior to the procedure, and a beta-blocker. On initial attempt at endoscopy, the patient was found to have suboptimal bowel prep and scheduled for follow-up colonoscopy the next day. Despite repeat suboptimal prep, the procedure was performed uneventfully and accomplished without resistance or looping. 10 hours post-discharge, the patient presented to the ED with 10/10 LUQ pain radiating to the left shoulder. At this time, the patient was pale and diaphoretic with BP 82/50 and HR 72/min. On exam, there was marked tenderness in the LUQ with voluntary guarding and without rebound. Laboratory evaluation revealed WBC 14.4 × 103/µL; Hb 8.9 g/L; platelets 420 × 103/µL. Troponins were normal, and EKG showed non-specific abnormalities. CT of the abdomen revealed a large peri-splenic hematoma 13.7 × 13.5 cm with moderate hemoperitoneum, but without distinctive splenic laceration. Despite a transient response to fluid resuscitation, the patient’s hemodynamic status continued to deteriorate, necessitating transfusion and subsequent splenectomy indicated for active bleeding from a splenic pedicle. DISCUSSION: Splenic laceration is a rare complication of colonoscopy (incidence 0.00005–0.17%) associated with significant mortality (5%), and as such requires a low threshold of suspicion for early diagnosis and management in the post-colonoscopy period. Anticoagulation, a requisite for management of cardiovascular comorbidities, is a notable risk factor and may predispose to splenic capsular rupture with minimal colonoscopic manipulation.Figure 1.: CT abdomen demonstrating large peri-splenic hematoma (13.7 × 13.5 cm) with moderate hemoperitoneum.