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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 -
Radiology Case Reports Nov 2023Wandering spleen manifests when the splenic ligaments are underdeveloped, or become lax, thereby allowing the spleen to relocate from its anatomical site to more distant...
Wandering spleen manifests when the splenic ligaments are underdeveloped, or become lax, thereby allowing the spleen to relocate from its anatomical site to more distant areas. During such movements, torsion of the long splenic peduncle is common, which can lead to symptoms of acute abdomen and further complications such as infarction. It is typically seen in children and young females. Our report presents a case of a 22-year-old female presenting to the ER with complaints of severe pain in the abdominal region. On ultrasound, there was suspicion of an adnexal mass, which was later confirmed to be a misplaced spleen in the lower abdomen, with torsion, fat stranding, and splenic vein thrombosis, as revealed by enhanced CT abdomen and pelvic MRI. It was followed by an emergency splenectomy. As wandering spleen presents nonspecifically and is a rare condition, it is important to consider wandering spleen when patients present similarly to this case, to prevent misdiagnosis and to deliver surgical treatment quickly to preserve the spleen.
PubMed: 37727144
DOI: 10.1016/j.radcr.2023.08.069 -
The Journal of Emergency Medicine Oct 2023A wandering spleen (WS) is a rare clinical entity characterized by a spleen located in the lower part of the abdomen or the pelvic cavity rather than the normal...
BACKGROUND
A wandering spleen (WS) is a rare clinical entity characterized by a spleen located in the lower part of the abdomen or the pelvic cavity rather than the normal anatomical site. The complications of a wandering spleen include splenic torsion, splenic infarction, and adjacent visceral injury.
CASE REPORT
We present a case of a male patient admitted to the emergency department with vomiting, nausea, and persistent lower abdominal pain. Computed tomography and ultrasound were performed and were used to diagnose a wandering spleen with torsion leading to splenic infarctions. Subsequently, laparoscopic surgery and pathology confirmed this diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultrasound and computed tomography scans play a significant role in diagnosing WS and its complications, allowing an emergency physician to establish treatment options for WS.
PubMed: 37716902
DOI: 10.1016/j.jemermed.2023.06.003 -
Cureus Jul 2023This case report of a rare condition involving situs inversus partialis, wandering spleen, and a single atrium. Situs inversus partialis is a congenital developmental...
This case report of a rare condition involving situs inversus partialis, wandering spleen, and a single atrium. Situs inversus partialis is a congenital developmental defect in which the abdominal or thoracic organs are reversed to the opposite side of the body across the sagittal plane. The case report highlights the congenital developmental anomaly and the diagnostic and management complexities associated with this condition. The patient in this case has survived to the age of 24, despite the presence of a single atrium. In the existing literature, situs inversus is a known congenital condition, but partial situs inversus is less common. A wandering spleen is also a rare condition characterized by splenic hypermobility. The combination of situs inversus partialis, a wandering spleen, and a single atrium is particularly unusual and has limited reported cases. Therefore, this research contributes to the existing literature by providing a unique case report and highlighting the challenges associated with diagnosis and management in such cases.
PubMed: 37581126
DOI: 10.7759/cureus.41860 -
The American Journal of the Medical... Dec 2023
Topics: Humans; Wandering Spleen; Infarction; Splenectomy
PubMed: 37567471
DOI: 10.1016/j.amjms.2023.08.005 -
Gastrointestinal Endoscopy Jan 2024
Topics: Humans; Wandering Spleen; Esophageal and Gastric Varices
PubMed: 37423540
DOI: 10.1016/j.gie.2023.07.005