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Cirugia Y Cirujanos 2021Wandering spleen is a rare condition, generally due to congenital abnormalities of the dorsal mesogastrium or splenic suspensory ligaments and not traumatic events. The...
Wandering spleen is a rare condition, generally due to congenital abnormalities of the dorsal mesogastrium or splenic suspensory ligaments and not traumatic events. The most frequent complication is torsion of the splenic hilus with ischemia or splenic infarction and its association with pancreatic volvulus is extremely rare. There are no reported cases of wandering spleen with pancreatic volvulus in association with a post traumatic Grynfelt-Lesshaft haernia. We present a case of a 43-year-old female patient with an association of these three entities and a history of abdominal trauma.
Topics: Adult; Female; Humans; Intestinal Volvulus; Splenectomy; Splenic Infarction; Torsion Abnormality; Wandering Spleen
PubMed: 34762623
DOI: 10.24875/CIRU.20000813 -
World Journal of Clinical Cases Oct 2021The floating spleen refers to the spleen moving away from the normal anatomical position to other parts of the abdominal cavity.
BACKGROUND
The floating spleen refers to the spleen moving away from the normal anatomical position to other parts of the abdominal cavity.
CASE SUMMARY
In this report, we describe two cases of torsion of floating spleen, which were successfully treated by laparoscopic partial splenectomy and retroperitoneal fixation of the residual spleen. The clinical characteristics of previously reported cases are also discussed.
CONCLUSION
In conclusion, laparoscopic partial resection of splenic volvulus infarction and extraperitoneal fixation of residual spleen are safe and reliable.
PubMed: 34734060
DOI: 10.12998/wjcc.v9.i29.8812 -
Cureus Sep 2021The wandering spleen (WS) is a rare condition in which the spleen is not found in its usual location in the left hypochondrium but is positioned in the lower abdomen or...
The wandering spleen (WS) is a rare condition in which the spleen is not found in its usual location in the left hypochondrium but is positioned in the lower abdomen or the pelvis. This is a case of a 21-year-old woman who presented with chronic, intermittent, and subtle pain in the left lower quadrant of her abdomen. After clinical examination and ultrasound evaluation, an adnexal lesion was detected in the left lumbar area, and no splenic tissue was found in the left hypochondrium. The wandering spleen should be included in the differential diagnosis when encountering a patient with non-typical or acute abdominal pain. Accurate diagnostic evaluation can be performed with low-cost imaging modalities such as Doppler ultrasound.
PubMed: 34703712
DOI: 10.7759/cureus.18231 -
The Surgeon : Journal of the Royal... Oct 2022Splenic torsion is a rare condition but one that many surgeons will encounter once in their career. Management options are varied but due to the rarity of the condition... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Splenic torsion is a rare condition but one that many surgeons will encounter once in their career. Management options are varied but due to the rarity of the condition there are no contemporary evidence-based summaries to inform a treating clinician. We aim to describe patterns of presentation and provide an evidence-based guide to the management.
METHODS
A PRISMA structured meta-analysis was conducted of all published cases of splenic torsion and a recent case added from our institution.
RESULTS
408 cases were identified between 1888 and 2021 and a single case added from our institution, 312 cases were sourced from case reports and 96 from 40 case series. 8% of patients had a co-existing congenital anomaly and 28% an identified risk factor for splenic torsion. 82% required emergency surgery. A preoperative diagnosis is becoming more common, reaching 80% in 2020's. While spleen conserving surgery is feasible using a variety of techniques. splenectomy was the definitive management for the majority (82%). On histopatholy no occult disease was identified and a significant number of resected spleens were potentially viable; 32% were reported to be normal or congested and 14% demonstrated only partial or focal necrosis.
DISCUSSION
Despite the significant publication bias implied by the methodology this is a large dataset in a rare condition. Splenic torsion frequently occurs in a premorbid population. The presence of a palpable mass in the context of abdominal pain should increase suspicion and trigger cross sectional imaging. Conservation of the spleen, using the techniques discussed, should be seriously considered.
Topics: Abdominal Pain; Humans; Splenectomy; Splenic Diseases; Torsion Abnormality
PubMed: 34666939
DOI: 10.1016/j.surge.2021.08.006 -
Clinical Case Reports Oct 2021We accidentally detected a subclinical wandering spleen on preoperative ultrasonography in a cat with gastrointestinal lymphoma. If the spleen is not in the normal...
We accidentally detected a subclinical wandering spleen on preoperative ultrasonography in a cat with gastrointestinal lymphoma. If the spleen is not in the normal position, the wandering spleen should be considered.
PubMed: 34631075
DOI: 10.1002/ccr3.4891 -
Surgical Endoscopy Dec 2021Minimal access surgery has opened avenues of hybrid approach for abdominal hydatid cysts extending into thorax. This approach of combined laparoscopy and thoracoscopy...
BACKGROUND
Minimal access surgery has opened avenues of hybrid approach for abdominal hydatid cysts extending into thorax. This approach of combined laparoscopy and thoracoscopy should be evaluated for its feasibility and efficacy.
AIM
Present prospective study was designed to highlight the feasibility and utility of endoscopic approach in the management of complex hydatid cyst of the liver and spleen extending into the thorax.
MATERIAL AND METHODS
Patients undergoing combined Laparoscopy and thoracoscopy for abdominal hydatid cysts extending into thorax over a period of 4 years were included in the study. Their clinical features, investigations, imaging, treatment and duration of hospital stay were studied. Clinical outcomes were assessed with respect to morbidity and mortality using Calvien Dindo scale.
RESULTS
A total of 15 patients were studied. All patients had thoracic hydatid cysts with liver involvement in 12, splenic involvement in 2, and both liver and spleen in 1 patient. The most common symptom was pain in the abdomen in 11 patients (73.3%) followed by lump in the abdomen in 2 patients (13.33%), and dyspnoea in 2 patients (13.33%). Computed Tomography was diagnostic in all patients. Most common type was Gomez type 1 (7 patients) followed by Gomez type II (3 Patient) and Gomez type III (2 patient). The mean operative time was 120 min. Mean hospital stay was 10 days. Pleural effusion being the commonest postoperative sequelae.
CONCLUSION
This endoscopic approach for liver and splenic hydatid cyst extending into thorax is feasible and averts morbidities of thoracotomy.
Topics: Abdomen; Animals; Echinococcosis; Echinococcosis, Hepatic; Humans; Laparoscopy; Parasites; Prospective Studies; Thorax
PubMed: 34410500
DOI: 10.1007/s00464-021-08682-w -
International Journal of Surgery Case... Aug 2021A wandering spleen is characterized by excessive splenic mobility due to the laxity of its ligaments, which leads to spleen migration and its long mobile vascular...
INTRODUCTION AND IMPORTANCE
A wandering spleen is characterized by excessive splenic mobility due to the laxity of its ligaments, which leads to spleen migration and its long mobile vascular pedicle is liable to torsion. The purpose of this paper was to present a wandering splenomegaly reduction after splenic detorsion and splenopexy.
CASE PRESENTATION
A 14-year-old boy presented a symptomatic visible pelvic wandering splenomegaly with torsion of the splenic pedicle. He was submitted to laparotomy, detorsion of the spleen, and splenopexy to the left diaphragm and surrounded peritoneum. The patient had an uneventful follow-up and was discharged from the hospital on the second postoperative day. All laboratory exams went to normal. The size of the spleen reduced from the 22 × 16 × 13 cm before the treatment to 14 × 12 × 10 cm after the surgical procedure.
CLINICAL DISCUSSION
The most relevant aspect of this communication is the reduction of the huge splenomegaly to a normal size spleen after detorsion of the splenic vessels and splenopexy to the left diaphragm. Reduction of the splenic size is well-known after distal splenorenal shunt, but this is the first publication of a spontaneous splenic size reduction after treating a congestive wandering splenomegaly by detorsion of the spleen pedicle.
CONCLUSION
Ectopic congestive splenomegaly due to the splenic pedicle rotation is adequately treated by splenic detorsion and splenopexy in its proper subdiaphragmatic site, which reduces the splenic size to normal.
PubMed: 34388905
DOI: 10.1016/j.ijscr.2021.106273 -
World Journal of Hepatology Jul 2021The displacement of spleen from its normal location to other places is known as wandering spleen (WS) and is a rare disease. The repeated torsion of WS is due to the... (Review)
Review
The displacement of spleen from its normal location to other places is known as wandering spleen (WS) and is a rare disease. The repeated torsion of WS is due to the presence of long pedicle and absence/laxity of anchoring ligaments. A WS is an extremely rare cause of left-sided portal hypertension (PHT) and severe gastric variceal bleeding. Left-sided PHT usually occurs as a result of splenic vein occlusion caused by splenic torsion, extrinsic compression of the splenic pedicle by enlarged spleen, and splenic vein thrombosis. There is a paucity of data on WS-related PHT, and these data are mostly in the form of case reports. In this review, we have analyzed the data of 20 reported cases of WS-related PHT. The mechanisms of pathogenesis, clinico-demographic profile, and clinical implications are described in this article. The majority of patients were diagnosed in the second to third decade of life (mean age: 26 years), with a strong female preponderance (M:F = 1:9). Eleven of the 20 WS patients with left-sided PHT presented with abdominal pain and mass. In 6 of the 11 patients, varices were detected incidentally on preoperative imaging studies or discovered intraoperatively. Therefore, pre-operative search for varices is required in patients with splenic torsion.
PubMed: 34367498
DOI: 10.4254/wjh.v13.i7.774 -
Nederlands Tijdschrift Voor Geneeskunde May 2021A wandering spleen is a relatively unknown condition, where the spleen may be enlarged and is located in an aberrant position in the abdomen. It is caused by abnormally...
BACKGROUND
A wandering spleen is a relatively unknown condition, where the spleen may be enlarged and is located in an aberrant position in the abdomen. It is caused by abnormally constructed or absent ligaments that should keep the spleen in the correct position or an excessively long vascular stem. The pathophysiology is congenital or secondary to trauma, abdominal surgery, pregnancy or splenomegaly.
CASE DESCRIPTION
A 21-year-old woman was presented at the emergency department with acute abdominal pain in the left lower quadrant. A CT-scan of the abdomen showed splenomegaly, with the spleen showing reduced blood flow and a location in the lower abdomen. During an emergency laparoscopy, the spleen was found to be ischemic based on a torsion of the vascular pedicle. A splenectomy followed and the patient showed an uncomplicated recovery.
CONCLUSION
Splenopexy or splenectomy is the treatment of choice for a symptomatic wandering spleen.
Topics: Abdomen, Acute; Abdominal Pain; Adult; Female; Humans; Laparoscopy; Splenectomy; Torsion Abnormality; Wandering Spleen; Young Adult
PubMed: 34346582
DOI: No ID Found -
Journal of Surgical Case Reports Jun 2021Spleen is normally positioned in the left upper quadrant. Abnormal location where it is not found in its normal anatomical position is called wandering spleen (WS)....
Spleen is normally positioned in the left upper quadrant. Abnormal location where it is not found in its normal anatomical position is called wandering spleen (WS). Wandering spleen is a rare medical condition that occurs due to developmental abnormality or acquired laxity of the ligaments that hold the spleen in its normal anatomical position. It affects children and young adults, especially childbearing age women. Patients affected with this condition may present with nonspecific symptoms requiring a high index of suspicion. Here, we are presenting a 20-year-old female known to have WS ended up with infarcted WS requiring emergency splenectomy.
PubMed: 34221345
DOI: 10.1093/jscr/rjab277