Splenopexy Research Articles

Wandering spleen: as a differential diagnosis in pelvic masses

Wandering spleen is rare, particularly in children, and diagnosis is difficult. It usually occurs at 20 to 40 years of age, and most cases are seen in women. Diagnosis is difficult because of lack of symptoms, unless splenic torsion has occurred. Patients usually have an asymptomatic abdominal mass, an acute abdomen, or, most commonly, a mass associated with pain. Rarely may it present as hypersplenism. Treatment is operative because of complications associated with the condition. Splenopexy or splenectomy can be done. We report a rare case of wandering spleen in an old age women who was treated by splenectomy because of associated hypersplenism.

Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature.

Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia.

長期にわたり脾臓捻転を繰り返し特異的な側副血行路を形成した遊走脾の1例

長期にわたり脾臓捻転を繰り返し特異的な側副血行路を形成した遊走脾の1例

成人に発症した遊走脾に伴う胃軸捻転症の1例

症例は66歳の女性で，突然の上腹部痛，嘔気を主訴として受診した．初診時腹部単純CTで胃拡張症と診断し，内科入院で保存的加療を行った．症状の改善乏しく，CT再検して脾臓が胃の背側へ遊走して，胃前庭部が左上腹部に捻転して押し上げられていた．上部消化管造影検査でも幽門部が高位に存在しており，遊走脾に伴う胃軸捻転症の診断となった．内視鏡的整復を試みたが困難であり，手術目的に当科紹介となった．胃短軸捻転症で胃体部後壁に壊死による穿孔を認め，胃軸捻転解除術，胃腹壁固定術，大網被覆術を施行した．術後経過は良好で胃潰瘍もほぼ改善し，第13病日で退院した．胃軸捻転症はまれな疾患であるが，胃拡張を呈した急性腹症の診断の際には念頭に置くべき疾患であると考えられた．

The wandering spleen torsion

Wandering spleen is the absence of spleen at its normal left upper quadrant. It may be because of increased splenic mobility resulting from laxity or maldevelopment of the suspensary gastrosplenic, splenorenal, and phrenicocolic ligaments. Wandering spleen is prone for complications like trauma and torsion. Torsion is quite rare complication. Diagnosis of wandering spleen is quite difficult because of the lack of symptoms and signs until splenic torsion have occurred. Here we report an interesting case of a 16-year-old unmarried girl presenting with acute abdomen, diagnosed with wandering spleen torsion and managed surgically.

Wandering spleen: a surgical enigma

Wandering spleen, also referred to as ‘ptotic spleen’, is a rare clinical condition characterized by splenic migration form its normal left hypochondrial position to any other abdominal or pelvic position. Among the multifactorial etiologies proposed, laxity of the spleen’s primary supporting ligaments is the most agreed-upon hypothesis. We present one rare case of wandering spleen in an 11-year-old girl who presented with recurrent abdominal pain with no localizing features. Her abdominal examination revealed an intra-abdominal left iliac fossa lump with restricted mobility, which was confirmed as a wandering spleen by abdominal sonography and contrast-enhanced computed tomography. Intraoperatively, an infarcted spleen was encountered with tortuous, elongated, torsional splenic pedicle and a single dense adhesive band with descending colon. Splenectomy was offered to the patient. Post-operatively, the patient is healthy and symptom free at one-year follow-up. The rare clinical diagnosis of this condition, particularly in the paediatric age-group, makes it an enigma for the surgical world.

English

Wandering spleen is a rare clinical entity characterized by splenic hypermobility resulting from laxity or maldevelopment of supporting splenic ligaments 1 . Its major complication is splenic torsion, which is a potentially fatal surgical emergency2. We present a rare case of wandering spleen with torsion and splenic infarction in a multiparous patient.

Wandering spleen with torsion causing pancreatic volvulus and associated intrathoracic gastric volvulus. An unusual triad and cause of acute abdominal pain.

Wandering spleen is a rare medical entity in which the spleen is orphaned of its usual peritoneal attachments and thus assumes an ever wandering and hypermobile state. This laxity of attachments may even cause torsion of the splenic pedicle. Both gastric volvulus and wandering spleen share a common embryology owing to maldevelopment of the dorsal mesentery. Gastric volvulus complicating a wandering spleen is, however, an extremely unusual association, with a few cases described in literature. We present a case of a young female who presented with acute abdominal pain and vomiting. Radiological imaging revealed a intrathoracic gastric volvulus, torsion in an ectopic spleen, and additionally demonstrated a pancreatic volvulus - an unusual triad, reported only once, causing an acute abdomen. The patient subsequently underwent an emergency surgical laparotomy with splenopexy and gastropexy.

Laparoscopic splenectomy for a wandering spleen complicating gastric varices: report of a case.

Wandering spleen is a rare clinical entity, and its chronic torsion of the vascular pedicle result in splenic vein occlusion leading to gastric varices. Here, we present a case of wandering spleen complicating gastric varices in a 40-year-old female. Three-dimensional CT (3D-CT) clearly showed the disruption of the splenic vein at the origin of the vascular pedicle and collateral development of the gastric varices. The patient was electively treated with laparoscopic splenectomy. Difficulty of prediction of the splenic vein recanalization to improve the varices was the reason for the use of splenectomy versus splenopexy. The varices were successfully diminished 3 months after the surgery. After review of cases of complicating gastric varices in the literatures, splenectomy is still a secure way to treat an adult patient with wandering spleen with complicating gastric varices.

Wandering spleen causing recurrent abdominal pain

Wandering spleen is a rare condition that accounts for < 0.25% of all indications for splenectomy. It is characterized by ectopic localization of the spleen owing to the lack or weakening of its ligaments. Clinical presentation is varied and ranges from asymptomatic abdominal mass to an abdominal mass with recurrent pain and acute abdomen following torsion of its pedicle. We report a case of wandering spleen in a 47-year-old female presenting with recurrent abdominal pain for a year duration, which was treated by splenectomy.

Torsion of a Wandering Spleen

Wandering spleen is a rare clinical condition characterized by ectopic positioning of the spleen due to abnormal peritoneal attachments including the lienorenal and gastrosplenic ligaments. The spleen can “wander” or migrate into various positions within the abdomen or pelvis due to this ligamentous laxity. The clinical presentation of patients with this entity is variable and can range from an incidental finding to an acute abdomen associated with torsion. Various imaging modalities can be utilized for the diagnosis of this condition .A variable treatment options for torsion of wandering spleen include splenectomy or splenopexy. Here we described a case of 32 years young lady with acute abdomen due to torsion of a wandering spleen. Diagnosis was made on the basis of clinical findings and abdominal ultrasound. Laparotomy was performed and the infarcted spleen was removed. DOI: http://dx.doi.org/10.3329/jbcps.v31i4.21008 J Bangladesh Coll Phys Surg 2013; 31: 219-222

An Etiologic Dilemma of Wandering Spleen in Childhood: Is it Congenital or Acquired?

To the Editor: Wanderingspleen(WS) isdefined ashypermo-bility of spleen due to lack of fixation and abnormally longsplenicpedicle.WeherepresentapatientwithWSanddiscussthe etiology of this rare entity.A 15-y-old girl presented to the emergency departmentwith an acute left quadrant abdominal pain, lasting for sixhours, with associated nausea and vomiting. She had amonozygotic twin sibling. Physical examination revealeddiffuse abdominal tenderness with rebound tenderness andguarding. Plain radiograph of the abdomen showed bowelloops occupying the left upper quadrant (Fig.1). Abdom-inal ultrasonography demonstrated a inferomedial dis-placement of the spleen. An abdominal contrast enhancedcomputed tomography revealed that the spleen was locat-ed inferomedial of its normal anatomical position andshowed normal enhancement pattern with a long splenicpedicle (Fig. 2). An urgent explorative laparotomyshowed the laxity of splenic ligamentous attachments with360° clockwise torsion of a macroscopically normalspleen around its exceptionally long pedicle. Followingthe derotation, the spleen was sutured to the diaphragmand abdominal wall directly. Her monozygotic twin sib-ling’s ultrasonography was normal.CongenitalandacquiredetiologicalfactorsareproposedtoexplaintheetiologyofWS,becauseofthehighincidencebothin childhood and in women during the active reproductiveyears [1–3]. According to congenital theory, absence ofligaments or abnormal development of the splenic peritonealattachments results in an abnormally long splenic pedicle andhypermobilityofspleen.Thistheoryissupportedbydetectingthe pancreatic tail in the splenic pedicle during the surgicalmanagement and the presence of recurrent pancreatitis asso-ciated with WS [4]. According to acquired theory, the in-creased association of WS with pregnancy and multiparityreveals that the alteration of hormone levels and the laxity ofabdominalwallresultsinlengtheningofthesplenicligaments[5]. In our case, monozygotic twin sibling had a normallocated spleen. We suggest that congenital maldevelopmentof primary splenic ligaments is not the only predisposingfactor. The increased female:male ratio after ten years of age can

Conservative treatment of splenic infarction and intestinal obstruction caused by a wandering spleen

The underdevelopment or absence of the splenic suspensary ligaments can lead to an uncommon condition termed the wandering spleen. It is usually asymptomatic but can present with an acute abdomen when associated with torsion. Most authors advocate surgical treatment. Herein, we report a case of torsion with infarction of the spleen and intestinal obstruction in a 36-year-old female patient which was successfully managed conservatively.

Wandering spleen in children: a report of 3 cases and a brief literature review underlining the importance of diagnostic imaging

Wandering spleen is a rare condition in children that is often caused by loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication. To provide up-to-date information on the diagnosis, clinical management and diagnostic imaging approaches for wandering spleen in infants and children and to underline the importance of color Doppler US and CT in providing important information for patient management. We report a series of three children with wandering spleen treated at our children's hospital over the last 6years. All three underwent clinical evaluation, color Doppler US and CT and were surgically treated. We also reviewed 40 articles that included 55 patients younger than 18years reported in the Medline database from 2002 to 2012. We correlated pathological data with imaging findings. Color Doppler US, the first imaging modality in investigating abdominal symptoms in children with suspected wandering spleen, yielded a diagnostic sensitivity of 54.9%, whereas CT achieved about 71.7%. Radiologic evaluation has a major role in confirming the diagnosis of a suspected wandering spleen and avoiding potentially life-threatening complications requiring immediate surgery.

Torsion of wandering spleen as a rare reason for acute abdomen: A presentation of two cases

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.

MR Images of Infarction of Wandering Spleen Associated with Intestinal Non-rotation

Wandering spleen is a rare clinical condition characterized by ectopic position of the spleen due to abnormal peritoneal attachments including the lienorenal and gastrosplenic ligaments (1). Wandering spleen and intestinal malrotation share a common cause: the absence of an intraperitoneal visceral ligament (2). Wandering spleen presents a wide range of clinical manifestations, from incidental finding to life-threatening conditions. The laxity of such suspensory ligaments of spleen predisposes torsion of the splenic vascular pedicle, leading to splenic infarction (3). These fatal complications, however, are not characterized by specific clinical symptoms; hence, image evaluation is crucial for detecting such complications. Radiologic imaging features of wandering spleens have been reported in previous studies, but to our knowledge, only a few cases of infarcted wandering spleen were associated with intestinal malrotations (2, 4). Herein we describe MR images of an unusual case of infarction of wandering spleen in association with intestinal non-rotation in a pediatric patient.

Wandering spleen as acute abdomen

Wandering spleen is a rare clinical entity that accounts for only 0.1-0.2% of all splenectomies. Early diagnosis and intervention is necessary for the preservation of the spleen, especially in children. However, most of the times in acute settings a precise clinical diagnosis is difficult because of its similarity of presentation with other causes of acute abdomen resulting in delayed diagnosis. We present a 12-year-old boy with left-sided abdominal pain following a fall from a bed. His abdominal examination revealed an enlarged tender spleen. Abdominal ultrasound and computed tomography showed enlarged spleen with multiple areas of infarction and thrombosis of the splenic vein. At laparotomy a diagnosis of torsion of a wandering spleen with infarction was confirmed and splenectomy done. We present the management of the patient with wandering spleen that presented as acute abdomen with lower abdominal mass and briefly review the literature.

Laparoscopic transperitoneal left adrenalectomy and wandering spleen risk.

Background and Objectives:Laparoscopic transperitoneal left adrenalectomy (LTLA) has become the standard treatment for adrenal masses <6 cm. LTLA involves the dissection of splenic suspensory ligaments, which replicates their congenital absence or weakening, present in cases of wandering spleen (WS). WS is a rare condition in which the spleen migrates from the left upper quadrant to a more caudal location in the abdomen. A unique case of WS after LTLA was described by Corcione et al. In this prospective study, we investigated the possibility of WS as a consequence of LTLA.Methods:Twenty-four patients, 8 men and 16 women, who underwent LTLA with the dissection of splenoparietal and splenorenal ligaments were selected.Results:Clinical and ultrasonographic follow-up showed no evidence of postoperative WS.Conclusions:In the literature, WS is not commonly reported as a postoperative complication of LTLA. In effect, especially in the case of small adrenal masses, the spleen's repositioning in its seat is autonomous. However, the alarming possibility of WS should not be ignored, especially in the case of extensive dissection of the left colic flexure. It would be useful for other authors to signal this complication, so that different approaches and consequent results may be compared.

Wandering Spleen in an Adult Man Associated With the Horseshoe Kidney

IntroductionA wandering spleen occurs when there is a laxity of the ligaments that fix the spleen in its normal anatomical position.Case PresentationThis is a case report of a wandering spleen with horseshoe kidney in a 29-year-old male admitted with acute lower abdominal pain and vomiting to emergency department of Shariati hospital in Isfahan province. Sonographic examination showed a homogeneous 21 × 15 × 8 cm mass in the lower part of the abdomen and pelvis associated with a horseshoe kidney. Laparotomy confirmed the clinical and ultrasound findings.ConclusionsThe association of horseshoe kidney with a wandering spleen in this case may be due to an embryological anomaly.

Wandering spleen with gastric volvulus and intestinal non-rotation in an adult male patient

We report an extremely rare case of wandering spleen (WS) complicated with gastric volvulus and intestinal non-rotation in a male adult. A 22-year-old man who had been previously treated for Wilson disease was admitted with severe abdominal pain. Radiological findings showed WS in the midline of the pelvic area. The stomach was mesenteroaxially twisted and intestinal non-rotation was observed. Radiology results did not show any evidence of splenic or gastrointestinal (GI) infarction. Elective emergency laparoscopy confirmed WS and intestinal non-rotation; however, gastric volvulus was not observed. It was suspected that the stomach had untwisted when gastric and laparoscopic tubes were inserted. Surgery is strongly recommended for WS because of the high risk of serious complications; however, some asymptomatic adult patients are still treated conservatively, such as the patient in this study. The present case is reported with reference to the literature.