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Current Problems in Diagnostic Radiology 2018An ectopic (or "wandering") spleen results from abnormal ligamentous laxity failing to fixate the spleen in its normal location in the left upper quadrant. Ligamentous... (Review)
Review
An ectopic (or "wandering") spleen results from abnormal ligamentous laxity failing to fixate the spleen in its normal location in the left upper quadrant. Ligamentous laxity can be acquired due to conditions, such as splenomegaly or pregnancy, but is often congenital. Because of this laxity, there is an elongated vascular pedicle, which is prone to torsion and resultant splenic infarction. These patients generally present with abdominal pain and other nonspecific symptoms making the diagnosis very difficult to make clinically. As such, the radiologist plays a crucial role in the diagnosis and care of these patients, as often the diagnosis is only considered after imaging.
Topics: Contrast Media; Diagnosis, Differential; Humans; Tomography, X-Ray Computed; Wandering Spleen
PubMed: 28385371
DOI: 10.1067/j.cpradiol.2017.02.007 -
Abdominal Radiology (New York) May 2023The wandering spleen, wandering liver, and wandering kidney are rare diagnoses that can be asymptomatic or are associated with nonspecific symptoms, making the clinical... (Review)
Review
The wandering spleen, wandering liver, and wandering kidney are rare diagnoses that can be asymptomatic or are associated with nonspecific symptoms, making the clinical diagnosis elusive. In addition, given the small number of cases, these conditions are not well understood. Major complications of wandering spleen result from torsion of the vascular pedicle with resultant ischemia, physiologic dysfunction, and/or infarction. Wandering liver is commonly associated with bowel obstruction, particularly colonic volvulus, with very rare reports of hepatic ischemia or infarct. Wandering kidneys are not commonly associated with serious complications. In many cases, the wandering spleen, liver or kidney can be found in their anatomic position on static imaging and are only diagnosed during ultrasound or with serial radiographic or cross-sectional imaging with different patient positioning, or with prior studies demonstrating different locations of the involved organ. Treatment approaches for uncomplicated wandering spleen, liver, or kidney include watchful waiting and splenopexy, hepatopexy, or nephropexy, respectively. Complicated wandering spleens are treated with splenectomy. Given the variable clinical presentation of these conditions, imaging plays a pivotal role in diagnosing these rare and often incidentally discovered phenomena.
Topics: Humans; Wandering Spleen; Torsion Abnormality; Liver; Infarction; Kidney; Radiologists
PubMed: 36752858
DOI: 10.1007/s00261-022-03789-7 -
The New England Journal of Medicine Nov 2020
Topics: Abdominal Pain; Adult; Cholangitis, Sclerosing; Female; Humans; Magnetic Resonance Imaging; Spleen; Tomography, X-Ray Computed; Torsion Abnormality; Wandering Spleen
PubMed: 33207096
DOI: 10.1056/NEJMicm2003627 -
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 -
Emergency Radiology Oct 2020Wandering spleen (or ectopic spleen) is a rare anomaly resulting from hyperlaxity or even absence of the ligaments that hold the spleen in its anatomical position.... (Review)
Review
Wandering spleen (or ectopic spleen) is a rare anomaly resulting from hyperlaxity or even absence of the ligaments that hold the spleen in its anatomical position. Although more frequently a congenital condition, it can also be acquired. Torsion of the vascular pedicle is its potential main complication with subsequent development of splenic infarct. In this paper we will describe the pathogenesis, clinical manifestations, treatment options and radiological findings which allow the diagnosis of this entity.
Topics: Contrast Media; Diagnosis, Differential; Humans; Torsion Abnormality; Wandering Spleen
PubMed: 32424633
DOI: 10.1007/s10140-020-01786-1 -
Digestive and Liver Disease : Official... Apr 2021
Topics: Abdominal Pain; Acute Pain; Adult; Female; Humans; Splenomegaly; Tomography, X-Ray Computed; Wandering Spleen
PubMed: 32646735
DOI: 10.1016/j.dld.2020.06.025 -
Cirugia Espanola Mar 2018
Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Wandering Spleen
PubMed: 28774572
DOI: 10.1016/j.ciresp.2017.05.011 -
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 -
Surgery Apr 2014
Topics: Adult; Female; Humans; Laparoscopy; Spleen; Splenectomy; Tomography, X-Ray Computed; Treatment Outcome; Wandering Spleen
PubMed: 24656146
DOI: 10.1016/j.surg.2012.11.015 -
Abdominal Radiology (New York) Sep 2018
Topics: Diagnosis, Differential; Humans; Torsion Abnormality; Wandering Spleen
PubMed: 29450603
DOI: 10.1007/s00261-018-1488-1