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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 -
International Journal of Pediatrics &... Mar 2016
PubMed: 30805467
DOI: 10.1016/j.ijpam.2015.12.001 -
Cureus Feb 2024Wandering spleen, or hypermobile spleen, arises from the elongation or maldevelopment of the spleen's suspensory ligaments. This condition is a rare clinical entity,...
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.
PubMed: 38445142
DOI: 10.7759/cureus.53552 -
BMC Pediatrics Jul 2022Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and...
BACKGROUND
Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction.
METHODS
From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized.
RESULTS
There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4-170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient.
CONCLUSIONS
Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen.
Topics: Child; Female; Humans; Male; Splenectomy; Splenic Infarction; Thrombocytosis; Torsion Abnormality; Wandering Spleen
PubMed: 35864485
DOI: 10.1186/s12887-022-03484-y -
Journal of Surgical Case Reports Jan 2022Dwarfism associated with splenomegaly during teenage years is known. The purpose of this report was to present the first case of dwarfism associated with wandering...
Dwarfism associated with splenomegaly during teenage years is known. The purpose of this report was to present the first case of dwarfism associated with wandering splenomegaly. A 14-year-old boy presented a wandering splenomegaly and torsion of the splenic pedicle associated with a retarded growth and sexual underdevelopment characterized by lack of sexual maturity and absence of secondary sexual physical appearance. The patient was submitted to detorsion of the spleen, and splenopexy. After the surgery, the patient grew up, and his sexual characteristics developed to normal. The size of the spleen reduced from the 22 × 16 × 13 cm to 14 × 12 × 10 cm after the surgical procedure. This is the first report of dwarfism associated with wandering splenomegaly, which was successfully treated without partial or total splenectomy. After releasing the venous blood flow, the spleen reduced its dimension and the patient grew up to the expected family size.
PubMed: 35079332
DOI: 10.1093/jscr/rjab558 -
Gastroenterology Report Aug 2017Wandering spleen, also referred to as 'ptotic spleen', is a rare clinical condition characterized by splenic migration form its normal left hypochondrial position to any...
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.
PubMed: 26240117
DOI: 10.1093/gastro/gov034 -
The American Journal of Case Reports Sep 2020BACKGROUND Wandering spleen is a rare condition in which the spleen lacks the usual peritoneal attachments, resulting in increased intra-abdominal mobility.... (Review)
Review
BACKGROUND Wandering spleen is a rare condition in which the spleen lacks the usual peritoneal attachments, resulting in increased intra-abdominal mobility. Complications can occur due to the torsion of the splenic vascular pedicle, resulting in symptoms ranging from an incidental finding to an acute abdomen as a result of an ischemic necrosis of the spleen. CASE REPORT We present the case of a 25-year-old female patient who presented with a recurring abdominal pain associated with serum lipase and C-reactive protein elevation. The computed tomography scan revealed torsion of the splenic pedicle and hypoperfusion of the spleen. A surgical exploration was performed and a wandering spleen was diagnosed perioperatively. It was characterized by the lack of peritoneal ligaments, thus resulting in a splenic volvulus. A splenectomy was carried out due to the definite ischemic necrosis of the spleen. CONCLUSIONS The diagnosis of this rare condition can be very challenging since it can be presented with a vast variety of symptoms, mimicking other abdominal pathologies. The intermittent nature of an ultimate splenic torsion can add to the diagnostic challenge. Medical literature concerning the wandering spleen and knowledge about this pathology originates mainly from individual case reports. Despite the evolving diagnostic modalities available, this rare and ambiguous disorder remains misdiagnosed, and a high index of suspicion is needed for the appropriate diagnosis to be established.
Topics: Abdomen, Acute; Adult; Female; Humans; Intestinal Volvulus; Splenic Diseases; Torsion Abnormality; Wandering Spleen
PubMed: 32868755
DOI: 10.12659/AJCR.925301 -
Journal of Surgical Case Reports Feb 2024The phenomenon of a wandering spleen is rare with few published case reports. The cases published in the literature mainly result from acquired or congenital laxity of...
The phenomenon of a wandering spleen is rare with few published case reports. The cases published in the literature mainly result from acquired or congenital laxity of the spleen's anchoring ligaments. Our case demonstrates an uncommon complication and possibly the first reported case of an iatrogenic wandering spleen. We present an interesting case of a 51-year-old female patient with congenital adrenal hyperplasia, fibromyalgia, and rheumatoid arthritis who underwent robotic-assisted left adrenalectomy for a 10-cm adrenal mass. Postoperatively, she developed uncontrolled pain and gastric distension due to spleen entrapment, leading to an open laparotomy and splenectomy with gastric perforation repair. She made an uneventful recovery. The rarity of iatrogenic wandering spleen as well as our patient's complex medical history, including chronic steroid use, presented unique challenges in postoperative management. This case highlights the importance of thorough perioperative evaluation and careful surgical planning in patients with underlying conditions.
PubMed: 38404444
DOI: 10.1093/jscr/rjae088 -
Medicine Sep 2020Wandering spleen (WS) is a rare clinical entity characterized by splenic hypermobility caused by absent or abnormal laxity of the suspensory ligaments, which fix the... (Review)
Review
RATIONALE
Wandering spleen (WS) is a rare clinical entity characterized by splenic hypermobility caused by absent or abnormal laxity of the suspensory ligaments, which fix the spleen in its normal position. Due to abnormal attachment, the spleen is predisposed to torsion and a series of complications. Pediatric WS is mostly reported in children aged <10 years, especially among infants aged <1 year; it is uncommon among toddlers between 1 and 3 years. To the authors' knowledge, only seven cases of WS have been described previously. Herein, we present the case of a 3-year-old toddler with WS and splenic torsion.
PATIENT CONCERNS
A 3-year-old boy was presented to the pediatric emergency room with a 2-day history of abdominal pain and vomiting. The ultrasonographic examination revealed a mass in the left upper abdomen cavity and absence of spleen in its normal position. Computed tomography showed an enlarged displaced spleen occupying the left abdomen cavity with an elongated splenic vascular pedicle (whirl sign), suggesting splenic torsion.
DIAGNOSES
The patient was diagnosed that had WS and splenomegaly, with or without complications due to splenic torsion.
INTERVENTIONS
The patient underwent emergency laparotomy and splenectomy due to nonviability after detorsion.
OUTCOMES
The postoperative course was uneventful, and the patient was discharged on the 7th day postoperatively without complications. The patient had favorable outcome over a 1-year follow-up.
LESSONS
Herein, we reported the case of a toddler with WS with splenic torsion. Moreover, after reviewing relevant studies in literature, we presented our findings on the diagnosis and treatment of toddlers with WS. Toddlers with WS are characterized by acute abdominal pain, unclear history description, examination restrictions, and high rates of life-threatening complications. High level of suspicion, careful physical examination, detailed history collection, and objective investigation are crucial in the management of toddlers with WS.
Topics: Abdomen, Acute; Child, Preschool; Humans; Male; Splenectomy; Splenic Diseases; Tomography, X-Ray Computed; Torsion Abnormality; Ultrasonography; Vomiting; Wandering Spleen
PubMed: 32925740
DOI: 10.1097/MD.0000000000022063 -
JSLS : Journal of the Society of... 2014Laparoscopic transperitoneal left adrenalectomy (LTLA) has become the standard treatment for adrenal masses<6 cm. LTLA involves the dissection of splenic suspensory...
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.
Topics: Adrenal Gland Diseases; Adrenalectomy; Adult; Aged; Female; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Prospective Studies; Wandering Spleen
PubMed: 25392630
DOI: 10.4293/JSLS.2014.00278