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Cureus May 2023Gastric volvulus is a rare clinical condition characterized by a pathological rotation of the stomach greater than 180º around its axis. The wandering spleen is also an...
Gastric volvulus is a rare clinical condition characterized by a pathological rotation of the stomach greater than 180º around its axis. The wandering spleen is also an exceptional clinical entity characterized by the absence or laxity of splenic ligaments which lead to splenic mobility in the abdominal cavity from its normal anatomical site. Wandering spleen and gastric volvulus association is unusual. Both can be life-threatening if left untreated. We herein present a rare, unusual association of mesenteroaxial gastric volvulus with wandering spleen in a two-year-old child and interpret the radiological findings to ensure correct and early diagnosis.
PubMed: 37265917
DOI: 10.7759/cureus.38386 -
International Journal of Surgery Case... Jun 2023The spleen is normally found in the left hypochondrium and it is fixed in its place by numerous suspensory ligaments. When the ligaments are elongated or abnormally...
INTRODUCTION AND IMPORTANCE
The spleen is normally found in the left hypochondrium and it is fixed in its place by numerous suspensory ligaments. When the ligaments are elongated or abnormally developed, it causes a rare medical condition called Wandering spleen. A persistent ascending and descending mesocolon is also a congenital anomaly, resulting from the failure of fusion of the primitive dorsal mesocolon.
CASE PRESENTATION
Herein, a 5-year-old male child with sudden and acute onset of abdominal pain, constipation, nausea, tachycardia, and low urine output, imaging and blood tests revealed evidence of intestinal obstruction and normocytic anemia and neutrophilia. A laparotomy revealed persistent ascending and descending mesocolon, with a torsioned vascular pedicle of the spleen, resulting in splenomegaly and infarction. The surgeon successfully derotated the torsioned pedicle and performed a splenectomy. The patient had an uneventful postoperative course and was discharged without complications.
CLINICAL DISCUSSION
This case could be asymptomatic and the diagnosis is incidental or it could be presented with ambiguous symptoms. The differential diagnosis of WS varies according to the clinical presentation and the associated complication. For instance, in the case of WS torsion and acute presentation, the differential diagnosis is ovarian torsion, acute appendicitis, and intestinal obstruction. Currently, surgery is the only suggested treatment option even in asymptomatic patients as well.
CONCLUSION
This case of a Wandering Spleen is associated with a persistent ascending and descending mesocolon, suggesting that there may be certain risk factors. Therefore, we suggest making more research about wandering spleen in association with persistent mesocolon.
PubMed: 37263001
DOI: 10.1016/j.ijscr.2023.108319 -
JPMA. the Journal of the Pakistan... Dec 2022Wandering spleen and gastric volvulus are two of the rarely encountered conditions occurring together with or without other congenital and acquired defects. These...
Wandering spleen and gastric volvulus are two of the rarely encountered conditions occurring together with or without other congenital and acquired defects. These potentially fatal conditions originate from a shared cause, i.e. the defect of intraperitoneal ligaments resulting in a failure to withhold these organs at their anatomical position and alignment. This can come to attention in both childhood and/or adulthood, and the diagnosis calls for a high degree of suspicion and a failure to diagnose can culminate in death of both the organs, i.e. the spleen and stomach. We are presenting the case of a 20-year-old girl who underwent an emergency laparotomy for gastric volvulus and wandering spleen.
Topics: Female; Humans; Adult; Child; Young Adult; Stomach Volvulus; Wandering Spleen; Splenectomy
PubMed: 37246688
DOI: 10.47391/JPMA.4839 -
Cureus Feb 2023The clinical presentation of a wandering spleen is characterized mainly by unspecific acute symptoms, ranging from diffuse abdominal pain to left upper/lower quadrant...
The clinical presentation of a wandering spleen is characterized mainly by unspecific acute symptoms, ranging from diffuse abdominal pain to left upper/lower quadrant and referred shoulder pain to asymptomatic. This has challenged accelerated medical care and impeded the acquisition of confirmatory diagnosis; therefore, increasing morbidity and mortality risks. Splenectomy is an established operative procedure for a wandering spleen. However, there has not been enough literature emphasizing the clinical history of congenital malformations and surgical corrections as inferential tools for facilitating a decisive and informed procedure. The case presented is of a 22-year-old female who reported to the emergency department with a five-day persistent left upper quadrant and left lower quadrant (LLQ) abdominal pain, associated with nausea. According to the medical history, the patient had a significant history of vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula, renal anomalies, and limb abnormalities (VACTERL) associated with congenital anomalies. By the age of eight years, the patient had undergone multiple surgical interventions, including tetralogy of Fallot repair, an imperforate anal repair with rectal pull-through, Malone antegrade continence enema (MACE), and bowel vaginoplasty. Computed tomography imaging of the abdomen revealed evidence of a wandering spleen in the LLQ with associated torsion of the splenic vasculature (whirl sign). Intra-operatively, appendicostomy was identified extending from the cecum in a near mid-line position, to the umbilicus, and carefully incised distally, preventing injury to the appendicostomy. The spleen was identified in the pelvis, and the individual vessels were clamped, divided, and ligated. Blood loss was minimal with no post-operative complications. This rare case report adds valuable teaching points about the treatment of wandering spleen in individuals with VACTERL anomalies.
PubMed: 37007360
DOI: 10.7759/cureus.35543 -
The Pan African Medical Journal 2022Situs inversus is a rare anomaly characterized by mirror-image location of of thoracic and abdominal organs. It can be associated with several other malformations...
Situs inversus is a rare anomaly characterized by mirror-image location of of thoracic and abdominal organs. It can be associated with several other malformations including common mesentery which is a rare type of malrotation that develops as a result of the rotation of the intestines and with wandering spleen which is a rare anomaly characterized by the unusual position of the spleen in the abdomen and that most often occurs in children. We here report the case of a male patient aged 8 years diagnosed with these three entities. He was admitted with chronic abdominal pain. Ultrasound assessment was performed. Clinical examination showed sensitive pelvic mass. Ultrasound objectified abnormal position of the liver and spleen (the liver in the left hypochondrium and the spleen in the right hypochondrium) and an oval isoechogenic mass characterized by tissue structures within the echo image in the spleen, located in the supravesical fossa, lateralized to the right. CT scan confirmed that the liver occupied both hypochondria, with the hilus and gallbladder found on the midline; the splenic fossa was empty and the supra-vesical pelvic mass was homogeneous, isodense to splenic parenchyma and raised in the same way to the spleen (it was a floating spleen), its arterial vascular pedicle was directly connected to the abdominal aorta. Intestinal rotation abnormality suggesting common mesentery was also objectified.
Topics: Child; Humans; Male; Wandering Spleen; Niger; Situs Inversus; Ultrasonography; Digestive System Abnormalities; Peritoneum; Mesentery
PubMed: 36785695
DOI: 10.11604/pamj.2022.43.144.32397 -
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 -
Cureus Jan 2023The spleen is typically located in the left upper quadrant and is held in position by the suspensory ligaments, which include the gastrosplenic ligament, the splenorenal...
The spleen is typically located in the left upper quadrant and is held in position by the suspensory ligaments, which include the gastrosplenic ligament, the splenorenal ligament, and the phrenicocolic ligament. Abnormalities within these ligaments result in the mobility of the spleen, so it may be located in the pelvis or iliac region, which is termed a wandering spleen. We present a case of a middle-aged man who presented to the emergency department with generalized abdominal pain and diffuse guarding and tenderness. The patient had a previous history of peptic ulcer disease and multiple emergency department visits for gastritis. Given the assumed diagnosis of perforated viscus, the patient underwent a computed tomography scan that demonstrated the absence of the spleen in its usual location and showed an ectopic pelvic spleen. The patient underwent successful surgical treatment with splenopexy. The wandering spleen is a rare medical condition that presents a clinical diagnostic challenge and requires a high index of suspicion. Despite its rarity, the wandering spleen should be considered in patients with recurrent abdominal pain.
PubMed: 36741617
DOI: 10.7759/cureus.33246 -
Annals of the Royal College of Surgeons... Jul 2023A wandering spleen occurs when laxity or absence of the suspensory ligaments allows migration throughout the abdomen. Gastric outlet obstruction resulting from this... (Review)
Review
INTRODUCTION
A wandering spleen occurs when laxity or absence of the suspensory ligaments allows migration throughout the abdomen. Gastric outlet obstruction resulting from this abnormality is rare. We present a systematic literature search and a case that was managed successfully with surgical intervention at our centre.
METHODS
A systematic search of the PubMed, Embase™, Medline and Google Scholar™ databases was carried out employing the combined search terms "gastric outlet obstruction" AND "wandering spleen". Six results were included for final analysis.
RESULTS
All six search results described a single case each. Patients underwent surgical management (open or laparoscopic) after initial investigation utilising a range of modalities. There were no mortalities reported at 90 days. The single case we present was complicated by gastric perforation; the patient made a successful recovery following open splenopexy and stapled wedge resection of the stomach.
CONCLUSIONS
A wandering spleen is a rare diagnosis and there are only six reported cases of gastric outlet obstruction secondary to a wandering spleen in the literature. None report associated gastric perforation. There are a variety of presenting symptoms, intraoperative findings and operative techniques used to address the gastrosplenic abnormality. The case reported by our centre adds to this limited evidence base and demonstrates a successful outcome from definitive surgical management. We highlight the need to seek early gastro-oesophageal expertise if any gastric pathology is found together with anatomical abnormality of the spleen.
Topics: Humans; Gastric Outlet Obstruction; Laparoscopy; Splenectomy; Wandering Spleen; Case Reports as Topic
PubMed: 36688842
DOI: 10.1308/rcsann.2022.0149 -
International Journal of Surgery Case... Jan 2023Wandering spleen is an uncommon condition marked by splenic hypermobility due to laxity or underdevelopment of the supporting splenic ligaments. Patients may be...
INTRODUCTION AND IMPORTANCE
Wandering spleen is an uncommon condition marked by splenic hypermobility due to laxity or underdevelopment of the supporting splenic ligaments. Patients may be asymptomatic, have a palpable mass in the abdomen, or exhibit acute, long-lasting, or sporadic symptoms as a result of the spleen's pedicle torsion. The management should be determined by the spleen's vitality.
CASE PRESENTATION
We report a case of a 29-year-old male who presented with a 5-year history of progressive abdominal swelling, surgically managed as an intrabdominal tumor at a general hospital in Uganda, with a postoperative confirmation of a wandering spleen.
CLINICAL DISCUSSION
Wandering spleen is a rare condition both in high- and low-income countries. Clinical presentations vary from an asymptomatic abdominal mass to acute abdominal pain due to vascular pedicle torsion leading to splenic infarction. When possible, splenopexy is the procedure of choice, especially in children and in tropical countries, to avoid post-splenectomy sepsis. Splenectomy is the definitive treatment for spleen fracture, spleen infarction, or symptoms that recur after splenopexy.
CONCLUSION
Wandering spleen is a rare differential diagnosis of intrabdominal tumor that must be considered in patients with a palpable abdominal mass with or without acute or chronic abdominal pain. Though a CT scan is the best method to confirm the diagnosis, the radiologist's and surgeon's experience and keenness seem very vital in making the correct diagnosis. Intraoperative complete abdominal exploration by the surgeon is essential to confirm the radiological findings, to enhance the diagnosis, and to make the best treatment decision.
PubMed: 36608635
DOI: 10.1016/j.ijscr.2022.107863 -
Clinical Gastroenterology and... May 2023
Topics: Humans; Wandering Spleen; Abdominal Pain; Torsion Abnormality
PubMed: 36402370
DOI: 10.1016/j.cgh.2022.11.003