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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 -
Archive of Clinical Cases 2022Wandering spleen is a rare condition and defined as the spleen that is not in its normal anatomical position due to lack or laxity of suspensory ligaments. Etiological...
Wandering spleen is a rare condition and defined as the spleen that is not in its normal anatomical position due to lack or laxity of suspensory ligaments. Etiological factors are congenital and acquired. Splenic torsion, infraction, and rupture are life-threatening complications of wandering spleen. A 14-year-old girl patient presented to the emergency department with severe pain abdomen for 2 days. On physical examination, a large palpable mass in the mid of the abdomen was found, and CECT confirmed it as torsion of wandering spleen. Emergency exploration is done and splenectomy was done due to non-viability of the spleen. The Post-op period was uneventful. Acute torsion of wandering spleen is an extremely rare clinical entity and patient present in an emergency with clinical features of acute abdomen. They may also present with chronic pain abdomen and abdominal mass. Early diagnosis is vital for the preservation of the spleen. Radiological studies have an important role in an accurate diagnosis. Surgery is the gold standard treatment of wandering spleen. Surgery for splenopexy or splenectomy depends on the condition of the spleen during surgery. Timely diagnosis and interventions are crucial to prevent life-threatening complications of wandering spleen.
PubMed: 35813495
DOI: 10.22551/2022.35.0902.10204 -
Asian Journal of Surgery Nov 2022
Topics: Abdomen, Acute; Humans; Splenectomy; Wandering Spleen
PubMed: 35643897
DOI: 10.1016/j.asjsur.2022.05.073 -
Jornal Vascular Brasileiro 2022The spleen is supplied by blood flow through the splenic artery and vein. The purpose of this communication is to report an ectopic spleen supplied only by reverse flow...
The spleen is supplied by blood flow through the splenic artery and vein. The purpose of this communication is to report an ectopic spleen supplied only by reverse flow through the left gastro-omental vessels. A 14-year-old boy presented with pelvic splenomegaly supplied only by the left gastro-omental artery and veins connected to the inferior polar vessels, which were the only vessels communicating with the spleen. After detorsion of the spleen and splenopexy, the spleen returned to normal dimensions. The patient had uneventful follow-up. In conclusion, the left gastroepiploic vessels are able to maintain the entire spleen blood supply.
PubMed: 35571522
DOI: 10.1590/1677-5449.20210178 -
Radiology Case Reports Jul 2022Polysplenia Syndrome is a rare condition that refers to the presence of 2 or more spleens in association with other thoracoabdominal abnormalities. Here, we report a...
Polysplenia Syndrome is a rare condition that refers to the presence of 2 or more spleens in association with other thoracoabdominal abnormalities. Here, we report a case of a 13-year-old girl who presented with acute lower abdominal pain and was diagnosed with polysplenia syndrome after obtaining a CT scan of her chest, abdomen and pelvis. Diagnostic imaging also revealed the presence of a wandering spleen hanging in the lower abdomen and upper pelvic cavity and showing signs of infarction. The patient underwent splenectomy afterward and splenic torsion was confirmed intraoperatively. To the best of our knowledge, this was the first reported case of wandering spleen torsion in a patient with polysplenia syndrome. Physicians should keep in mind the possibility of a wandering spleen torsion presenting in various locations when dealing with polysplenia syndrome patients complaining of abdominal pain.
PubMed: 35570876
DOI: 10.1016/j.radcr.2022.04.009 -
Case Reports in Surgery 2022A wandering spleen is a rare anatomical condition characterized by a free-floating splenic tissue that is not located in its normal position in the left upper quadrant....
INTRODUCTION
A wandering spleen is a rare anatomical condition characterized by a free-floating splenic tissue that is not located in its normal position in the left upper quadrant. This condition is usually asymptomatic but can also manifest itself with volvulus of the spleen and consequent infarction and necrosis of the parenchyma, requiring an urgent surgical management. Additionally, a wandering spleen can be associated with other contemporaneous anatomical anomalies. . We report a case of a 21-year-old woman, admitted to our hospital for intense abdominal pain and vomiting. A CT scan revealed a wandering spleen in the mesogastric area with the spleen torted on its axis, associated with a volvulus of the small intestine. Abdominal exploration revealed a macroscopically normal free-floating spleen attached to an abnormally long vascular pedicle. The management of the wandering spleen was conservative, and a splenopexy was performed.
CONCLUSIONS
The torsion of the wandering spleen constitutes an infrequent but life-threatening abdominal emergency. The diagnosis of the wandering spleen is frequently challenging since clinical findings are usually not specific. Imaging such as computed tomography scan plays an important role in the differential diagnosis pathway. Treatment should be planned according to the splenic parenchyma conditions. Splenectomy is indicated when massive infarction and thrombosis of splenic vessels have occurred. When splenic parenchyma is not compromised, it is preferred to perform a conservative surgical technique, such as splenopexy, in order to avoid postsplenectomy complications.
PubMed: 35492869
DOI: 10.1155/2022/8696492 -
Radiology Case Reports Jun 2022Ectopic spleen is a rare clinical entity characterized by splenic hypermobility which may be congenital or acquired. The spleen may be migrated to different positions in...
Ectopic spleen is a rare clinical entity characterized by splenic hypermobility which may be congenital or acquired. The spleen may be migrated to different positions in the peritoneum. The main complication is pedicular torsion with splenic volvulus, presenting as an emergency abdominal surgery. We present and discuss a case of ectopic and twisted spleen resulting in complete splenic infarction, diagnosed by ultrasound, confirmed by CT scan and treated by splenectomy.
PubMed: 35479965
DOI: 10.1016/j.radcr.2022.03.045 -
Radiology Case Reports May 2022Wandering spleen is an uncommon cause of acute abdomen in children. Diagnosis of this condition is challenging due to its non-specific symptoms, varying intensity and...
Wandering spleen is an uncommon cause of acute abdomen in children. Diagnosis of this condition is challenging due to its non-specific symptoms, varying intensity and protracted history of presentation. Radiographs and ultrasound imaging provide rapid and reliable means to diagnose this condition without exposure to excessive radiation. We present a case of a torsed wandering spleen in a child with recurrent abdominal pain. We highlight the role of imaging in identifying salient radiographic and sonographic signs for diagnosis.
PubMed: 35369544
DOI: 10.1016/j.radcr.2022.03.017 -
Cureus Feb 2022Wandering spleen (WS) is a rare disease caused by the looseness of the splenic ligaments. A 29-year-old female patient presented to the emergency department with...
Wandering spleen (WS) is a rare disease caused by the looseness of the splenic ligaments. A 29-year-old female patient presented to the emergency department with complaints of abdominal pain and a palpable mass in the abdomen. A diagnosis of WS was made as a result of preoperative imaging. We performed urgent laparoscopic splenopexy with non-absorbable mesh in a patient with torsioned WS. WS is a disease that must be operated on urgently because it causes ischemia and necrosis in cases where it causes torsion in the splenic pedicle. Many researchers also recommend surgery in asymptomatic patients. While splenectomy was previously recommended for WS, current recommendations advocate for splenopexy. As a result, the only and definite treatment option in the case of WS is surgery. Splenopexy with minimally invasive techniques should be the first choice if possible. Splenopexy with non-absorbable mesh is an inexpensive and feasible method to prevent re-torsion. The use of non-absorbable mesh in laparoscopic splenopexy has not been shared before in the literature.
PubMed: 35355540
DOI: 10.7759/cureus.22597 -
Frontiers in Pediatrics 2021The management of wandering spleen (WS) with torsion, a rare pathological condition, is currently unclear. Most patients with this disorder are treated with surgical...
BACKGROUND
The management of wandering spleen (WS) with torsion, a rare pathological condition, is currently unclear. Most patients with this disorder are treated with surgical interventions, such as splenectomy or splenopexy.
CASE PRESENTATION
A newborn female presented with low hemoglobin (10.8 mg/L) and high total serum bilirubin (193 μmol/L) at 3 h of life. A palpable mass was observed during her physical examination, and a magnetic resonance imaging scan of the abdomen confirmed the presence of an infarcted WS with torsion. Upon conservative management with oral antibiotic prophylaxis, careful observation, and repeated follow-ups, the infant remained clinically stable. At 2 years of age, she had normal complete blood count, and a repeat technetium study revealed two splenunculi/splenules in the splenic bed.
CONCLUSION
Most patients with WS are treated surgically with splenectomy or splenopexy. Non-operative management may be a feasible treatment option in select cases with infarcted WS and may allow the natural process of autosplenectomy to occur.
PubMed: 35155313
DOI: 10.3389/fped.2021.791932