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Journal of Surgical Case Reports Feb 2024Wandering spleen (WS) is a rare condition characterized by the hypermobility of the spleen due to the absence or abnormal flexibility of suspensory ligaments. We present...
Wandering spleen (WS) is a rare condition characterized by the hypermobility of the spleen due to the absence or abnormal flexibility of suspensory ligaments. We present a 16-year-old female presented with intermittent abdominal pain, constipation, and a palpable mass in the right iliac fossa. Imaging revealed a WS associated with sigmoid volvulus and portal hypertension. Despite a decade of symptoms, the patient remained undiagnosed. Laparoscopic splenectomy was performed successfully, addressing both WS and sigmoid volvulus. The patient's symptoms resolved, and she was discharged in good condition. This case emphasizes the need for clinical awareness of WS in the differential diagnosis of abdominal pain. It highlights the role of imaging in prompt diagnosis and the necessity of surgical intervention. Our case sheds light on the association of WS with other conditions, providing clinicians with valuable insights for effective management.
PubMed: 38370603
DOI: 10.1093/jscr/rjae059 -
International Journal of Surgery Case... Mar 2024Gastric volvulus is an uncommon potentially life-threatening medical condition characterized by rotation of the stomach or part of the stomach around its longitudinal or...
INTRODUCTION AND IMPORTANCE
Gastric volvulus is an uncommon potentially life-threatening medical condition characterized by rotation of the stomach or part of the stomach around its longitudinal or transverse axis. Acute gastric volvulus usually presents with the triads of epigastric pain, nonproductive retching, and inability to pass the nasogastric tube. Diagnosis is assisted with abdominal and chest x-ray and contrast studies.
CASE PRESENTATION
A 53-year-old female presented with abdominal pain of two days duration which started at the epigastric region and later on became diffuse all over the abdomen. She had associated frequent episodes of vomiting which were initially bilious followed by nonproductive retching and low-grade intermittent fever. Abdominal examination showed a distended, diffusely tender abdomen with an ill-defined epigastric mass. Abdominal X-ray showed central abdominal circular opacity continuous with stomach outline. Intraoperative findings revealed perforated gangrenous mesenteroaxial gastric volvulus and splenopancreatic torsion with wandering spleen. Proximal subtotal gastrectomy with esophagogastric anastomosis and splenopexy was performed. The patient was discharged on the 10th postoperative day and had an uneventful post-operative recovery.
CLINICAL DISCUSSION
Primary gastric volvulus is usually mesenteroaxial with the pylorus commonly rotating anteriorly. Primary gastric volvulus can be associated with congenital asplenia and wandering spleen as both conditions are characterized by absent or loose ligamentous attachments. This case was a mesenteroaxial volvulus with splenopancreatic torsion with a wandering spleen caused by abnormal ligamentous attachments.
CONCLUSION
A high index of suspicion for early diagnosis of gastric volvulus and timely intervention is required to improve treatment outcome.
PubMed: 38308980
DOI: 10.1016/j.ijscr.2024.109338 -
Journal of Minimal Access Surgery Jan 2024With only seven reported cases until 2019 as noted by Lim et al., cases of a wandering spleen (WS) accompanied by splenic cyst (SC) are exceptionally rare. Furthermore,...
With only seven reported cases until 2019 as noted by Lim et al., cases of a wandering spleen (WS) accompanied by splenic cyst (SC) are exceptionally rare. Furthermore, both entities are notoriously 'silent' until they present as an emergency with complications, often warranting total splenectomy. Management of SC in a WS eventually depends on its clinical presentation, disease type and functional reservoir of the spleen. However, it is desirable to operate electively and perform a spleen salvage with splenic reposition surgery. Our case describes the first totally laparoscopic partial splenectomy and intraperitoneal fixation of the spleen by means of gastropexy for a large non-parasitic SC in a WS. Partial splenectomy instead of just a cystectomy tackles the risk of cyst recurrence, and a gastropexy over other splenic repositioning techniques would allow the spleen to remain as an intraperitoneal organ.
PubMed: 38240265
DOI: 10.4103/jmas.jmas_212_23 -
Cureus Dec 2023The report highlights a rare instance of colonic volvulus due to a wandering spleen. Wandering spleen is characterized by the displacement of the spleen due to absent or...
The report highlights a rare instance of colonic volvulus due to a wandering spleen. Wandering spleen is characterized by the displacement of the spleen due to absent or weakened ligaments due to congenital factors or acquired factors such as pregnancy or prior surgery leading to ligament disruption. The 26-year-old patient presented with severe abdominal pain and distention, leading to a diagnosis of sigmoid volvulus secondary to the wandering spleen. This case underscores the importance of considering the wandering spleen in the differential diagnosis of acute abdomen, especially in patients with a surgical history of gastric sleeve resection. The article emphasizes the critical role of imaging in diagnosis and the necessity of timely surgical intervention to prevent severe complications. The case contributes to a broader understanding of the wandering spleen, particularly in post-surgical contexts, highlighting diagnostic challenges and management strategies.
PubMed: 38222125
DOI: 10.7759/cureus.50447 -
Clinical Case Reports Dec 2023Wandering spleen results from abnormal ligamentous laxity and is often symptomatic, presented with abdominal pain and other non-specific symptoms. These symptoms, make...
Wandering spleen results from abnormal ligamentous laxity and is often symptomatic, presented with abdominal pain and other non-specific symptoms. These symptoms, make the diagnosis very difficult and most of the times even impossible. As such, keeping in mind this pathology, can make further complications less frequent.
PubMed: 38033686
DOI: 10.1002/ccr3.8270 -
Clinical and Experimental... 2023Gastric volvulus is an uncommon clinical condition with the potentially life-threatening complication of acute gastric necrosis. A wandering spleen may also be...
Gastric volvulus is an uncommon clinical condition with the potentially life-threatening complication of acute gastric necrosis. A wandering spleen may also be associated with gastric volvulus and can produce a diagnostic dilemma as the cause of an acute abdomen. We present a case of an elderly woman who presented with acute abdominal symptoms. She did not have the classical Borchardt triad to diagnose gastric volvulus and had a coexisting wandering spleen. Although torsion and ischemia of the wandering spleen were initially thought to be the cause of acute abdomen, a subsequent contrast-enhanced CT (CECT) scan confirmed a coexistent mesenteric-axial gastric volvulus with gangrenous changes. We present this case to highlight a rare combination of pathologies, either of which can confuse the diagnosis or cause a delay in management. Early diagnosis with CECT is emphasized, and segmental resection is feasible when the rest of the viscus can be preserved.
PubMed: 37904894
DOI: 10.2147/CEG.S428679 -
World Journal of Clinical Cases Oct 2023Wandering spleen is rare clinically. It is characterized by displacement of the spleen in the abdominal and pelvic cavities and can have congenital or acquired causes....
BACKGROUND
Wandering spleen is rare clinically. It is characterized by displacement of the spleen in the abdominal and pelvic cavities and can have congenital or acquired causes. Wandering spleen involves serious complications, such as spleen torsion. The clinical symptoms range from asymptomatic abdominal mass to acute abdominal pain. Surgery is required after diagnosis. Cases of wandering spleen torsion with portal vein thrombosis (PVT) are rare. There is no report on how to eliminate PVT in such cases.
CASE SUMMARY
Ultrasound and computed tomography revealed a diagnosis of wandering spleen torsion with PVT in a 31-year-old woman with a history of childbirth 16 mo previously who received emergency treatment for upper abdominal pain. She recovered well after splenectomy and portal vein thrombectomy combined with continuous anticoagulation, and the PVT disappeared.
CONCLUSION
Rare and nonspecific conditions, such as wandering splenic torsion with PVT, must be diagnosed and treated early. Patients with complete splenic infarction require splenectomy. Anticoagulation therapy and individualized management for PVT is feasible.
PubMed: 37901012
DOI: 10.12998/wjcc.v11.i28.6955 -
SAGE Open Medical Case Reports 2023Splenic volvulus of wandering spleen is a rare clinical condition. It causes significant morbidity and mortality, especially if undetected. Here, we report a case of...
Splenic volvulus of wandering spleen is a rare clinical condition. It causes significant morbidity and mortality, especially if undetected. Here, we report a case of 32-year-old female who presented with worsening abdominal pain for 1-week duration. Contrast-enhanced computed tomography scan of the abdomen showed splenic volvulus with infarction and involvement of the pancreatic tail. She underwent exploratory laparotomy and splenectomy with preservation of the pancreatic tail. Patient progressed favourably. Our case report describes a rare clinical entity of a splenic volvulus with a twisted pancreatic tail. This is a life-threatening condition that requires prompt diagnosis and treatment.
PubMed: 37860287
DOI: 10.1177/2050313X231205812 -
International Journal of Surgery Case... Nov 2023Wandering spleen (WS) is a clinical entity in which the spleen is not located in its normal anatomical site. Few cases have been reported, mainly in women of...
INTRODUCTION
Wandering spleen (WS) is a clinical entity in which the spleen is not located in its normal anatomical site. Few cases have been reported, mainly in women of childbearing age. This condition can be congenital or acquired due to excessive elasticity of the spleen's suspensory ligaments. WS may cause acute complications requiring emergency surgery, especially related to the rotation of its vascular pedicle, leading to chronic or acute ischemia. The aim of the present case is to show a rare complication of WS, small bowel obstruction (SBO), and its management.
PRESENTATION OF CASE
We report the case of a 40-year-old female presenting with abdominal pain, nausea, and vomiting. CT scan showed SBO caused by WS located in the pelvis with an enlarged spleen vascular pedicle (SVP). Laparoscopic exploration, splenectomy, small bowel resection and anastomosis were performed.
DISCUSSION
WS may cause chronic or acute complications, mainly linked with enlargement and torsion of SVP, including acute ischemia and spleen necrosis, or compression of the near organs such as small intestine, stomach, pancreas. The diagnosis is based on physical examination, CT scan and blood exams. Generally, the WS's treatment is laparoscopic splenectomy or splenopexy. In case of vital spleen, splenopexy can be performed, in case of not vital spleen, splenectomy should be preferred.
CONCLUSION
This case provides an excellent example of SBO related to WS. In the video, the management of this complex situation is shown. In these cases, splenectomy represents a valuable option.
PubMed: 37839258
DOI: 10.1016/j.ijscr.2023.108961 -
International Journal of Surgery Case... Oct 2023Wandering spleen (WS) is a rare condition, occurring in only 0.2 % of cases, where the spleen becomes hypermobile due to the absence or laxity of its anchoring...
INTRODUCTION
Wandering spleen (WS) is a rare condition, occurring in only 0.2 % of cases, where the spleen becomes hypermobile due to the absence or laxity of its anchoring ligaments. Torsion of the spleen, primarily seen in children but occasionally in adults, is a critical complication that can lead to infarction and is considered a medical emergency.
CLINICAL PRESENTATION
We present a case report of a 50-year-old woman with type 2 diabetes and psychiatric illness presented with 2 days of vomiting, abdominal pain, and dehydration. Physical examination showed a tender mass in the abdomen and imaging confirmed a twisted spleen with a thrombosed splenic vein, leading to a successful emergency splenectomy. The patient had an uncomplicated recovery and was discharged with post-splenectomy protocol.
DISCUSSION
Splenic torsion, a rare occurrence primarily observed in children. Clinical diagnosis is aided by palpable abdominal masses and confirmed by radiological imaging. The gold standard diagnostic tool is contrast-enhanced computed tomography (CT), whereas Ultrasonography (USG) is equally good in early assessment. Early identification is crucial to salvage the spleen. Management options include detorsion, splenopexy, or splenectomy depending on the organ viability. Elective splenopexy has emerged as a proactive measure, particularly in children, to prevent complications.
CONCLUSION
Splenic torsion is a rare but important differential diagnosis in patients presenting with acute abdomen. Early diagnosis and prompt management is necessary to preserve the spleen and to prevent the development of complication. Surgery is often necessary and either splenopexy or splenectomy should be done.
PubMed: 37797525
DOI: 10.1016/j.ijscr.2023.108898