-
SAGE Open Medical Case Reports 2024Gastric volvulus and wandering spleen are two rare and uncommon conditions. Gastric volvulus is characterized by the rotation of the stomach around itself, causing a...
Gastric volvulus and wandering spleen are two rare and uncommon conditions. Gastric volvulus is characterized by the rotation of the stomach around itself, causing a closed obstruction. It was first described in the 19th century and is classified according to the axis, etiology, or chronicity. A wandering spleen is defined by the absence of one or all of the splenic ligaments, which occurs either for congenital or acquired reasons. An enlarged spleen may contribute to the wandering spleen and, in turn, lead to gastric volvulus and infarction of the stomach, requiring emergency surgical intervention. In this report, we present a case of a 19-year-old female who presented to the emergency department with severe abdominal pain and epigastric distension. After performing the necessary investigations, she was diagnosed with a wandering spleen and acute gastric volvulus. An immediate laparotomy was performed and both the spleen and the stomach were resected to save the patient's life at the right time.
PubMed: 38881967
DOI: 10.1177/2050313X241262141 -
International Journal of Surgery Case... May 2024Wandering spleen (WS) is a rare clinical condition found in less than 0.5 % of splenectomies and is characterized by ectopic location of the spleen within the abdomen...
INTRODUCTION
Wandering spleen (WS) is a rare clinical condition found in less than 0.5 % of splenectomies and is characterized by ectopic location of the spleen within the abdomen or pelvis. It is always caused by excessive mobility brought on by the ligamentous laxity of its peritoneal attachments. Abdominal ultrasonography and computed tomography are the key imaging modalities for inquiry of WS.
CASE PRESENTATION
We report the case of a 47-year-old woman who presented with painless abdominal swelling since the age of 6 years. An abdominal examination revealed a palpable, firm, mobile mass in the right lower abdomen approximately 15 × 15 cm in dimensions. A contrast CT scan of the abdomen revealed the absence of the spleen in the left upper quadrant. The patient was managed conservatively and followed for five years with favourable outcome.
DISCUSSION
Failure of the dorsal mesogastrium to merge with the posterior abdominal wall in the second month of embryonic development is one of the reasons for WS. The nonsurgical conservative approach is limited to patients who are high-risk surgical candidates and have minimal symptoms and no complications.
CONCLUSION
The good clinical outcome of our patient suggests that conservative non-surgical approach may be a reasonable alternative to unwarranted surgical intervention in selected clinically stable patients who have no evidence of splenic torsion or infarction, avoiding the possible complications of surgery.
PubMed: 38823227
DOI: 10.1016/j.ijscr.2024.109834 -
Journal of Medical Case Reports May 2024Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic... (Review)
Review
BACKGROUND
Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not.
CASE PRESENTATION
We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful.
CONCLUSION
Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.
Topics: Humans; Female; Wandering Spleen; Adult; Abdominal Pain; Splenectomy; Tomography, X-Ray Computed; Pelvic Pain; Spleen
PubMed: 38790071
DOI: 10.1186/s13256-024-04580-6 -
International Journal of Surgery Case... Jun 2024Wandering spleen may result in torsion or splenomegaly, which causes symptoms such as intestinal obstruction, nausea, vomiting, and swelling in the abdomen. There are...
INTRODUCTION AND IMPORTANCE
Wandering spleen may result in torsion or splenomegaly, which causes symptoms such as intestinal obstruction, nausea, vomiting, and swelling in the abdomen. There are few reports of wandering spleen torsion in pregnant mothers. The diagnosis and presentation of splenic torsion is variable and challenging during pregnancy. Herein, we present a case of torsion of a wandering spleen in a 30-year-old pregnant patient.
CASE PRESENTATION
A 30-year-old female presented with a sudden onset of abdominal pain of three days' duration. There was lower abdominal mass and tenderness. Intraoperative findings revealed enlarged spleen located over the lower abdominal cavity with six times clockwise rotation of the splenic pedicle over itself. A splenectomy was performed. The patient was discharged on the 7th postoperative day and had an uneventful postoperative recovery.
CLINICAL DISCUSSION
Patient presentation could be asymptomatic, chronic left abdominal pain or symptoms and signs of complication. The most common complication of wandering spleen is torsion (Abell, n.d.). Splenic torsion is evidenced by mucosal bleeding, hematemesis, anemia or thrombocytopenia in our patient platelets level was 111,000 cells/μl which suggests vascular thrombosis. The other peculiarity during pregnancy is torsion of the spleen have higher mortality reaching up to 41 % (Lewis and Wolskel, 1962) which may be from delay in diagnosis or misdiagnosis.
CONCLUSION
There is high mortality associated with splenic torsion in pregnant patient reported in the literature. One of the explanations is misdiagnosis and delay in diagnosis of torsion of a wandering spleen in a pregnant patient.
PubMed: 38704970
DOI: 10.1016/j.ijscr.2024.109721 -
Annals of Medicine and Surgery (2012) May 2024Wandering spleen (WS) is a rare condition that occurs when the spleen is not in its normal anatomical location, but in the abdominal or pelvic cavity. The mechanism of...
INTRODUCTION AND IMPORTANCE
Wandering spleen (WS) is a rare condition that occurs when the spleen is not in its normal anatomical location, but in the abdominal or pelvic cavity. The mechanism of this condition may be due to dysfunction of ligaments that fixate the spleen in its position. Female hormonal alterations during pregnancy and other unknown causes in children may also play role in an ectopic spleen.
CASE PRESENTATION
The authors report a case of a 34-year-old woman who presented to the emergency department with intermittent abdominal pain that persisted after childbirth without other symptoms.
CLINICAL DISCUSSION
Clinically the symptoms are varied and abdominal pain is the most common presentation. Radiological investigation of WS include ultrasound, MRI, and CT, which is the most preferred tool. Treatments after the diagnosis include splenectomy or splenopexy either through laparoscopy or laparotomy.
CONCLUSION
Physicians should include ectopic spleen as a differential diagnosis in a multiparous woman with the presentation of acute or chronic abdominal pain.
PubMed: 38694347
DOI: 10.1097/MS9.0000000000001960 -
Radiology Case Reports Jul 2024Wandering spleen is a rare condition in children that is often caused by the loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of...
Wandering spleen is a rare condition in children that is often caused by the loss or weakening of the splenic ligaments. Its clinical presentation is variable; 64% of children with wandering spleen have splenic torsion as a complication. A 13-year-old boy who had been showing abdominal pain in the hypogastric region accompanied by vomit and an enormous tumefaction in the suprapubic region came to our observation. Considering the ovoid morphology at ultrasound exam, the echostructure and the marked reduction of parenchymal vascularization, suspicion for torsion of an ectopic spleen arose. Ultrasound evaluation has a primary role in the diagnosis of a suspected wandering spleen and, to avoid potentially life-threatening complications, immediate surgery is often times required.
PubMed: 38689812
DOI: 10.1016/j.radcr.2024.03.004 -
Journal of Medical Case Reports Apr 2024Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal...
BACKGROUND
Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed.
CASE PRESENTATION
A 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days.
CONCLUSION
Splenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.
Topics: Female; Humans; Wandering Spleen; Splenic Diseases; Splenomegaly; Ovarian Cysts
PubMed: 38615066
DOI: 10.1186/s13256-024-04502-6 -
Frontiers in Oncology 2024Ectopic spleen (ES) is a rare condition. It is difficult to diagnose with conventional imaging modalities. In this case series, we presented the imaging features of...
Ectopic spleen (ES) is a rare condition. It is difficult to diagnose with conventional imaging modalities. In this case series, we presented the imaging features of three misdiagnosed ES cases in our hospital and previously reported cases to compare the consistency of enhancement patterns among different imaging modalities with varied phases. Finally, 22 cases were reviewed. We determined that variable arterial phase enhancement and persistent enhancement throughout the portal and delayed phases are present in contrast-enhanced ultrasound (CEUS) imaging of the ES and found the arterial phase of CEUS had the highest consistency compared with computerized tomography (CT) and magnetic resonance imaging (MRI).
PubMed: 38529386
DOI: 10.3389/fonc.2024.1310394 -
Cureus Feb 2024Wandering spleen, or hypermobile spleen, arises from the elongation or maldevelopment of the spleen's suspensory ligaments. This condition is a rare clinical entity,...
Wandering spleen, or hypermobile spleen, arises from the elongation or maldevelopment of the spleen's suspensory ligaments. This condition is a rare clinical entity, primarily affecting children, with a higher prevalence among adult females in the active reproductive age group. Manifestations may include an asymptomatic abdominal mass or intermittent abdominal discomfort due to the torsion and subsequent spontaneous detorsion of the spleen. This case report details the presentation of a 14-year-old female initially misdiagnosed as having gastroenteritis who later experienced acute abdomen. Subsequent ultrasonography and computed tomography scan revealed splenic torsion, confirmed during exploratory laparotomy, which demonstrated an infarcted spleen. The definitive therapeutic intervention was a total splenectomy. This clinical entity should be taken into account in the differential diagnosis of acute abdominal pain in order to aid in early diagnosis and management. This could allow us to avoid splenectomy whenever possible and instead do splenopexy, especially in pediatric cases, as the spleen plays a crucial role in the reticuloendothelial system.
PubMed: 38445142
DOI: 10.7759/cureus.53552 -
Journal of Surgical Case Reports Feb 2024The phenomenon of a wandering spleen is rare with few published case reports. The cases published in the literature mainly result from acquired or congenital laxity of...
The phenomenon of a wandering spleen is rare with few published case reports. The cases published in the literature mainly result from acquired or congenital laxity of the spleen's anchoring ligaments. Our case demonstrates an uncommon complication and possibly the first reported case of an iatrogenic wandering spleen. We present an interesting case of a 51-year-old female patient with congenital adrenal hyperplasia, fibromyalgia, and rheumatoid arthritis who underwent robotic-assisted left adrenalectomy for a 10-cm adrenal mass. Postoperatively, she developed uncontrolled pain and gastric distension due to spleen entrapment, leading to an open laparotomy and splenectomy with gastric perforation repair. She made an uneventful recovery. The rarity of iatrogenic wandering spleen as well as our patient's complex medical history, including chronic steroid use, presented unique challenges in postoperative management. This case highlights the importance of thorough perioperative evaluation and careful surgical planning in patients with underlying conditions.
PubMed: 38404444
DOI: 10.1093/jscr/rjae088