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International Journal of Surgery Case... Aug 2021A 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...
INTRODUCTION AND IMPORTANCE
A 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 PRESENTATION
A 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 DISCUSSION
The 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.
CONCLUSION
Ectopic 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.
PubMed: 34388905
DOI: 10.1016/j.ijscr.2021.106273 -
World Journal of Hepatology Jul 2021The 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... (Review)
Review
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.
PubMed: 34367498
DOI: 10.4254/wjh.v13.i7.774 -
Clinical Case Reports Nov 2021Splenic arteriovenous torsion causes splenomegaly and ischemic necrosis of the spleen. The recommended treatment for wandering spleen with hypersplenism is considered to...
Splenic arteriovenous torsion causes splenomegaly and ischemic necrosis of the spleen. The recommended treatment for wandering spleen with hypersplenism is considered to be splenectomy.
PubMed: 34765218
DOI: 10.1002/ccr3.5051 -
Journal of Minimal Access Surgery 2019Wandering spleen present generally as an acute abdomen after twisting of the splenic vascular pedicle. This study aimed to review the literature with regard to the... (Review)
Review
AIM
Wandering spleen present generally as an acute abdomen after twisting of the splenic vascular pedicle. This study aimed to review the literature with regard to the management and outcomes of the laparoscopy in children with wandering spleen.
METHODS
The literature was reviewed for articles on PubMed with regard to the following search terms 'laparoscopy', 'wandering', 'spleen' and 'children'. The inclusion criteria included article only in the paediatric age group of 0-16. Articles that did not meet the inclusion criteria were excluded from the study.
RESULTS
The PubMed search from 1998 to 2016 identified 15 articles. There were 20 children with an age range from 2 to 16 years who underwent the laparoscopic procedure for wandering spleen. The median age was 8 years. Associated conditions were present in 45% of patients: gastric volvulus (n = 3), torsion of the distal pancreas (n = 3), splenic cyst (n = 2), mental retardation and myotonic dystrophy (n = 1). In two cases, the spleen was twisted around the pedicle and was non-viable, and therefore, a splenectomy was performed. Other 18 cases were managed by splenopexy using a 3-5-port technique. An extraperitoneal pocket was created using a balloon device in five patients. Fixation of the spleen was performed using a mesh in 10 cases and omentum in three cases. In one case, additional support was created by plicating the phrenicocolic ligament. Simultaneous gastropexy was performed in four patients. There were no post-operative complications.
CONCLUSIONS
Wandering spleen is a rare entity and in the paediatric age group 10% cannot be salvaged for which splenectomy is the only option. Of the 90% that can be pexied, the literature has favoured the application of meshes followed by the extraperitoneal pockets and omental pouch. Laparoscopic splenopexy is feasible, with no reported conversions or complications.
PubMed: 29737310
DOI: 10.4103/jmas.JMAS_14_18 -
Radiology Case Reports Sep 2022Wandering spleen, also known as ectopic spleen, is a rare condition in which the spleen's anatomical location is other than its fixed position in the abdomen's left...
Wandering spleen, also known as ectopic spleen, is a rare condition in which the spleen's anatomical location is other than its fixed position in the abdomen's left upper quadrant. The cause of such an abnormality could be due to congenital or acquired factors, which could ultimately lead to torsion and splenic infarct. Given the nonspecific clinical symptoms and the potential complications associated with wandering spleen, computed tomography scans provide a crucial means for proper diagnosis. In this article, we report the case of a 16-year-old female with a diagnosis of wandering spleen with torsion and splenic infarct.
PubMed: 35874869
DOI: 10.1016/j.radcr.2022.06.073 -
JPMA. the Journal of the Pakistan... Dec 2022Wandering spleen and gastric volvulus are two of the rarely encountered conditions occurring together with or without other congenital and acquired defects. These...
Wandering spleen and gastric volvulus are two of the rarely encountered conditions occurring together with or without other congenital and acquired defects. These potentially fatal conditions originate from a shared cause, i.e. the defect of intraperitoneal ligaments resulting in a failure to withhold these organs at their anatomical position and alignment. This can come to attention in both childhood and/or adulthood, and the diagnosis calls for a high degree of suspicion and a failure to diagnose can culminate in death of both the organs, i.e. the spleen and stomach. We are presenting the case of a 20-year-old girl who underwent an emergency laparotomy for gastric volvulus and wandering spleen.
Topics: Female; Humans; Adult; Child; Young Adult; Stomach Volvulus; Wandering Spleen; Splenectomy
PubMed: 37246688
DOI: 10.47391/JPMA.4839 -
Radiologia 2019In imaging studies, some developmental anomalies such as perisplenic accessory spleen are easily recognizable due to their high incidence. However, other, less common... (Review)
Review
In imaging studies, some developmental anomalies such as perisplenic accessory spleen are easily recognizable due to their high incidence. However, other, less common anomalies such as intrapancreatic accessory spleen, splenopancreatic fusion, splenogonadal fusion, heterotaxy, and wandering spleen, as well as acquired conditions such as splenosis, can pose diagnostic difficulties. This aim of this review is to show the imaging diagnosis and differential diagnoses of these uncommon splenic anomalies.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Spleen
PubMed: 30087001
DOI: 10.1016/j.rx.2018.07.002 -
The Israel Medical Association Journal... Jun 2018Wandering spleen is a rare entity that may pose a surgical emergency following torsion of the splenic vessels, mainly because of a delayed diagnosis. Complications after...
BACKGROUND
Wandering spleen is a rare entity that may pose a surgical emergency following torsion of the splenic vessels, mainly because of a delayed diagnosis. Complications after surgery for wandering spleen may necessitate emergency treatment.
OBJECTIVES
To describe the clinical course and treatment for children who underwent emergency surgeries for wandering spleen at a tertiary pediatric medical center over a 21 year period and to indicate the pitfalls in diagnosis and treatment as reflected by our experience and in the literature.
METHODS
The database of a tertiary pediatric medical center was searched retrospectively for all children who underwent emergency treatment for wandering spleen between 1996 and 2017. Data were collected from the medical files. The relevant literature was reviewed.
RESULTS
Of ten patients who underwent surgery for wandering spleen during the study period, five underwent seven emergency surgeries. One patient underwent surgery immediately at initial presentation. In the other four, surgical treatment was delayed either due to misdiagnosis or for repeated imaging studies to confirm the diagnosis. Emergency laparotomy revealed an ischemic spleen in all patients; splenectomy was performed in two and the spleen was preserved in three. Four of the seven emergency operations were performed as the primary surgery and three were performed to treat complications.
CONCLUSIONS
Wandering spleen should ideally be treated on an elective or semi-elective basis. Surgical delays could be partially minimized by a high index of suspicion at diagnosis and by eliminating unnecessary and time-consuming repeated imaging studies.
Topics: Adolescent; Child; Child, Preschool; Databases, Factual; Delayed Diagnosis; Emergencies; Female; Humans; Laparotomy; Male; Postoperative Complications; Retrospective Studies; Splenectomy; Tertiary Care Centers; Time Factors; Treatment Outcome; Wandering Spleen
PubMed: 29911755
DOI: No ID Found -
Surgical Case Reports Sep 2022Congenital diaphragmatic hernia (CDH) is sometimes associated with complications involving herniation of intrathoracic organs, which further increase mortality rate. We...
BACKGROUND
Congenital diaphragmatic hernia (CDH) is sometimes associated with complications involving herniation of intrathoracic organs, which further increase mortality rate. We encountered a case of postoperative gastric and splenic volvulus shortly after left CDH repair in a female neonate who was treated with gastropexy.
CASE PRESENTATION
At 39 weeks gestation, a female patient with left Bochdalek CDH was delivered (birth weight: 3748 g, Apgar score: 3/4). The patient was provided ventilator support with nitric oxide. After pulmonary hypertension improved, CDH repair was performed via the abdominal approach on day 7. The stomach, small intestine, large intestine, and spleen were herniated through a diaphragmatic defect of 4 × 2 cm. Although the diaphragm was directly closed, it was tight and the reconstructed diaphragm "dome" was shallow, restricting space for the spleen and stomach. Nonetheless, the spleen was positioned in the left upper abdomen and the stomach was positioned medially. The postoperative course was complicated by organo-axial gastric volvulus, and laparotomy was performed on day 14. In addition to the gastric volvulus, we confirmed a wandering splenic volvulus. The spleen was easily detorted and returned to the left upper abdomen. However, the patient experienced relapse of gastric volvulus without splenic volvulus. Gastropexy was performed electively on day 47. Postoperatively, the patient could be fed orally, and the patient's development was satisfactory 6 years after surgery.
CONCLUSIONS
The cause of these rare complications appeared to be tight direct diaphragmatic closure, which reduced space for the spleen and stomach beneath the left diaphragm.
PubMed: 36138238
DOI: 10.1186/s40792-022-01537-z -
International Journal of Surgery Case... 2017Accessory spleens are found in 10-15% of the population, and are even more prevalent in patients with hematological disorders (Rudowski, 1985). It infrequently may...
INTRODUCTION
Accessory spleens are found in 10-15% of the population, and are even more prevalent in patients with hematological disorders (Rudowski, 1985). It infrequently may become symptomatic due to torsion, spontaneous rupture or hemorrhage which may lead to death. Torsion of an accessory spleen is extremely rare, and requires prompt medical attention [2] (Coote et al., 1999).
PRESENTATION OF CASE
We report the case of a 27-year-old Mediterranean lady with thalassemia trait, who presented to the emergency department with an acute surgical abdomen due to torsion of a giant accessory spleen, measuring 13cm. She was diagnosed with the aid of ultrasound and computed tomography (CT) scan and was treated surgically through resection of the spleen.
DISCUSSION AND CONCLUSION
Torsion of an accessory spleen is not common, and is the surgical indication in about 0.2-0.3% of splenectomies (Mortele et al., 2004). It has variable clinical presentations, and is a difficult preoperative diagnosis due to lack of specificity of symptoms. Accessory spleens are usually smaller than 3cm, with few cases being reported as larger than 10cm larger accessory spleens have a higher rate of torsion. Knowledge of this pathology, and familiarity with its radiological findings are fundamental to accurately diagnosing and manageming this challenging condition.
PubMed: 28756363
DOI: 10.1016/j.ijscr.2017.07.037