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International Journal of Surgery Case... 2020Splenoptosis is an uncommon disorder defined as the dislodgment of the spleen from its anatomical location in the left hypochondrium to another location in the...
BACKGROUND
Splenoptosis is an uncommon disorder defined as the dislodgment of the spleen from its anatomical location in the left hypochondrium to another location in the intraabdominal cavity. This migration is the result of laxity or absence of the ligaments that fix the spleen to surrounding structures. Splenoptosis is either diagnosed after it causes symptoms, or incidentally using different imaging modalities. Surgery is the definite treatment either by splenopexy or splenectomy.
CASE PRESENTATION
In the case presented here, we discuss a 17 years old female patient who presented to our institution for acute onset of abdominal pain, mainly suprapubic, occurring for 4 days. Ultrasound showed a suspicious right pelvic mass, which was found to be a wandering spleen with pedicle torsion. The patient was treated surgically by splenectomy.
CONCLUSION
We report this rare case to encourage physicians to keep this etiology in mind as part of the differential diagnosis of unspecific abdominal pain.
PubMed: 33171434
DOI: 10.1016/j.ijscr.2020.11.001 -
International Journal of Surgery Case... 2020A congenital diaphragmatic hernia (CDH) is rarely diagnosed in adults and can allow passage of abdominal viscera into the chest cavity. A particularly rare association...
INTRODUCTION
A congenital diaphragmatic hernia (CDH) is rarely diagnosed in adults and can allow passage of abdominal viscera into the chest cavity. A particularly rare association is a wandering spleen due to absence of its diaphragmatic and retroperitoneal attachment which predisposes to elongation of the vascular pedicle with risk of torsion, infarction and rupture.
PRESENTATION OF CASE
A 17-year-old girl presented with a two-day history of increasing abdominal pain. Examination identified an abdominal mass. Computer tomography (CT) chest, abdomen and pelvis revealed a significantly enlarged wandering spleen with signs of torsion and an associated large left CDH with viscera in the chest cavity. The patient proceeded to an open splenectomy and repair of CDH. Post-operatively the patient developed ileus and required a temporary chest tube for pneumothorax, but otherwise progressed well.
DISCUSSION
Untreated CDH with a symptomatic wandering spleen is an extremely rare diagnosis with only one similar previous case report. Clinical detection is unlikely, making CT scanning the diagnostic test of choice. Surgery is recommended given the high morbidity and mortality of associated complications of both conditions. Splenic preserving options are favoured, however the majority of identified cases require splenectomy because of associated torsion or splenomegaly. Reduction of the CDH should be performed with primary closure of the defect and mesh reinforcement where possible.
CONCLUSION
CDH with associated wandering spleen in adults presents an extremely rare but clinically important diagnosis. Prompt surgical management as reported in this case should be performed to minimise immediate and future complications.
PubMed: 33137668
DOI: 10.1016/j.ijscr.2020.10.049 -
Journal of Radiology Case Reports Jul 2020Wandering spleen is a rare condition in which the spleen is hypermobile due to laxity or lack of its supporting ligaments. It can be located anywhere in the abdomen...
Wandering spleen is a rare condition in which the spleen is hypermobile due to laxity or lack of its supporting ligaments. It can be located anywhere in the abdomen besides its usual position. The other terms that are used to describe this condition are splenic ptosis, displaced spleen, dislocated spleen and ectopic spleen. Splenic torsion is a dreaded complication and the usual cause of symptoms. There is a high chance of missing the diagnosis as it remains asymptomatic or may be incidentally discovered on radio-imaging done for a different purpose. An acute abdomen is the most common presentation. Here we describe an unusual case presenting with torsion of the wandering spleen that was adherent to the right ovary.
Topics: Abdominal Pain; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Ovary; Splenectomy; Tomography, X-Ray Computed; Torsion Abnormality; Ultrasonography; Wandering Spleen; Young Adult
PubMed: 33088415
DOI: 10.3941/jrcr.v14i7.3752 -
Medicine Sep 2020Wandering spleen (WS) is a rare clinical entity characterized by splenic hypermobility caused by absent or abnormal laxity of the suspensory ligaments, which fix the... (Review)
Review
RATIONALE
Wandering spleen (WS) is a rare clinical entity characterized by splenic hypermobility caused by absent or abnormal laxity of the suspensory ligaments, which fix the spleen in its normal position. Due to abnormal attachment, the spleen is predisposed to torsion and a series of complications. Pediatric WS is mostly reported in children aged <10 years, especially among infants aged <1 year; it is uncommon among toddlers between 1 and 3 years. To the authors' knowledge, only seven cases of WS have been described previously. Herein, we present the case of a 3-year-old toddler with WS and splenic torsion.
PATIENT CONCERNS
A 3-year-old boy was presented to the pediatric emergency room with a 2-day history of abdominal pain and vomiting. The ultrasonographic examination revealed a mass in the left upper abdomen cavity and absence of spleen in its normal position. Computed tomography showed an enlarged displaced spleen occupying the left abdomen cavity with an elongated splenic vascular pedicle (whirl sign), suggesting splenic torsion.
DIAGNOSES
The patient was diagnosed that had WS and splenomegaly, with or without complications due to splenic torsion.
INTERVENTIONS
The patient underwent emergency laparotomy and splenectomy due to nonviability after detorsion.
OUTCOMES
The postoperative course was uneventful, and the patient was discharged on the 7th day postoperatively without complications. The patient had favorable outcome over a 1-year follow-up.
LESSONS
Herein, we reported the case of a toddler with WS with splenic torsion. Moreover, after reviewing relevant studies in literature, we presented our findings on the diagnosis and treatment of toddlers with WS. Toddlers with WS are characterized by acute abdominal pain, unclear history description, examination restrictions, and high rates of life-threatening complications. High level of suspicion, careful physical examination, detailed history collection, and objective investigation are crucial in the management of toddlers with WS.
Topics: Abdomen, Acute; Child, Preschool; Humans; Male; Splenectomy; Splenic Diseases; Tomography, X-Ray Computed; Torsion Abnormality; Ultrasonography; Vomiting; Wandering Spleen
PubMed: 32925740
DOI: 10.1097/MD.0000000000022063 -
The American Journal of Case Reports Sep 2020BACKGROUND Wandering spleen is a rare condition in which the spleen lacks the usual peritoneal attachments, resulting in increased intra-abdominal mobility.... (Review)
Review
BACKGROUND Wandering spleen is a rare condition in which the spleen lacks the usual peritoneal attachments, resulting in increased intra-abdominal mobility. Complications can occur due to the torsion of the splenic vascular pedicle, resulting in symptoms ranging from an incidental finding to an acute abdomen as a result of an ischemic necrosis of the spleen. CASE REPORT We present the case of a 25-year-old female patient who presented with a recurring abdominal pain associated with serum lipase and C-reactive protein elevation. The computed tomography scan revealed torsion of the splenic pedicle and hypoperfusion of the spleen. A surgical exploration was performed and a wandering spleen was diagnosed perioperatively. It was characterized by the lack of peritoneal ligaments, thus resulting in a splenic volvulus. A splenectomy was carried out due to the definite ischemic necrosis of the spleen. CONCLUSIONS The diagnosis of this rare condition can be very challenging since it can be presented with a vast variety of symptoms, mimicking other abdominal pathologies. The intermittent nature of an ultimate splenic torsion can add to the diagnostic challenge. Medical literature concerning the wandering spleen and knowledge about this pathology originates mainly from individual case reports. Despite the evolving diagnostic modalities available, this rare and ambiguous disorder remains misdiagnosed, and a high index of suspicion is needed for the appropriate diagnosis to be established.
Topics: Abdomen, Acute; Adult; Female; Humans; Intestinal Volvulus; Splenic Diseases; Torsion Abnormality; Wandering Spleen
PubMed: 32868755
DOI: 10.12659/AJCR.925301 -
Cureus Jul 2020Splenic infarction is a rare medical condition that usually occurs in the setting of hematologic disorders. It is rarely seen in previously healthy adolescents. A...
Splenic infarction is a rare medical condition that usually occurs in the setting of hematologic disorders. It is rarely seen in previously healthy adolescents. A wandering spleen increases the risk of splenic infarct due to risk of torsion and is more commonly seen in pregnancy due to increased elasticity of connective tissue. Wandering spleen may also be associated with diseases, such as Ehlers-Danlos, and should be suspected in the patient with possible underlying connective tissue dysfunction. Although rare, splenic infarction must be on the differential for unremitting upper epigastric pain, fever, and vomiting, particularly when patient medical history suggests connective tissue dysfunction. This case discusses the course of a pediatric patient with abdominal pain with complex medical history found to have splenic infarction secondary to torsion of a wandering spleen initially discovered on emergency CT imaging. Although rarely indicated in pediatric patients with abdominal pain, lower threshold for CT imaging for ruling out emergent etiology resulted in life-saving treatment. This case demonstrates the importance of clinical suspicion for emergency etiology of abdominal pain in pediatric patients with medical history suspicious for connective tissue dysfunction, and therefore lowering the threshold for CT imaging to rule out splenic infarction in these patients.
PubMed: 32802611
DOI: 10.7759/cureus.9176 -
International Journal of General... 2020Wandering spleen is a rare condition with less than 0.2% prevalence, and it is the cause of 0.25% of total splenectomies. This condition happens as a result of the lack...
BACKGROUND
Wandering spleen is a rare condition with less than 0.2% prevalence, and it is the cause of 0.25% of total splenectomies. This condition happens as a result of the lack or looseness of the spleen suspensory ligaments, and it may manifest as an acute abdomen due to the spleen becoming twisted around its vascular base.
CASE PRESENTATION
This study reports the case of a wandering spleen attached to the omentum (with blood supply from the omentum) in the pelvic area, with ectopic appendix (located in the right upper quadrant), ectopic liver (located in the abdominal midline), and ectopic stomach (located in the right upper abdominal region), in a 15-year-old male complaining about abdominal pain, nausea, vomiting, and lack of appetite, who was referred to the hospital. The patient underwent laparotomy with the diagnosis of acute abdomen; the twisted ectopic spleen in the pelvis was removed and appendectomy was also performed. The clinical manifestations of wandering spleen vary extensively, and its presurgical diagnosis is difficult in the absence of radiological studies. Therefore, spleen torsion has to be considered as a diagnosis for acute abdomen in order to prevent necrosis of the spleen and other related complications.
CONCLUSION
Wandering spleen should be borne in mind for patients presenting with a palpable intra-abdominal mass causing acute or intermittent abdominal symptoms.
PubMed: 32612378
DOI: 10.2147/IJGM.S248259 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2020Wandering spleen is a rare condition and has life-threatening complications, such as torsion or infarction. It may be asymptomatic or may present with chronic abdominal...
Wandering spleen is a rare condition and has life-threatening complications, such as torsion or infarction. It may be asymptomatic or may present with chronic abdominal pain or intraabdominal mass. Since clinical diagnosis is usually difficult, radiological examinations play a very important role in diagnosis. A 37-year-old multiparous woman was admitted to the emergency room with a complaint of abdominal pain. The patient stated that she underwent an operation due to gastric volvulus nine years ago. Preoperative diagnosis was made by ultrasonography and computed tomography. Splenectomy was performed because of the irreversible infarction. Wandering spleen torsion is a rare clinical condition that may cause an acute abdomen. Computerized tomography is the gold standard for preoperative diagnosis. Gastric volvulus and wandering spleen have similar etiologies. In the literature, the coexistence of these two diseases in adulthood is rarely reported. However, to our knowledge, this case is the first report to describe the emergence of these two pathologies at different times in adulthood.
Topics: Abdominal Pain; Adult; Female; Humans; Parity; Splenectomy; Stomach Volvulus; Wandering Spleen
PubMed: 32436983
DOI: 10.14744/tjtes.2019.91606 -
World Journal of Clinical Cases Apr 2020Axenfeld-Rieger syndrome (ARS) is an autosomal dominant genetic disease characterized by ocular developmental disorders and its association with torsion of wandering...
BACKGROUND
Axenfeld-Rieger syndrome (ARS) is an autosomal dominant genetic disease characterized by ocular developmental disorders and its association with torsion of wandering spleen (WS) has not been reported to date to the best of our knowledge. This study aimed to describe a rare case of ARS observed at our emergency department.
CASE SUMMARY
A 25-year-old female presented with a constant lower abdominal pain of increasing severity. Diagnostic computed tomography with intravenous contrast material showed a non-homogenously enhanced splenic parenchyma with a twisted vascular pedicle. Further, an emergent laparoscopic exploration was performed, and an ischemic spleen without its normal ligamentous attachments was noted. Notably, the spleen did not regain its normal vascularity after detorsion; thus, we performed the laparoscopic total splenectomy. The postoperative course was uneventful, and the patient was discharged on the 5 postoperative day. This case demonstrates a rare association of WS and ARS.
CONCLUSION
Early diagnosis of WS in the emergency department is important to prevent pedicle torsion or splenic necrosis and to avoid splenectomy.
PubMed: 32368543
DOI: 10.12998/wjcc.v8.i8.1502 -
Journal of Surgical Case Reports Feb 2020Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all spleen ligaments that fixate the spleen in the left upper quadrant....
Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all spleen ligaments that fixate the spleen in the left upper quadrant. Many different terms refer to wandering spleen like dislocated spleen, ectopic spleen and displaced spleen. We report in this case a 13-year-old Syrian girl presented to the emergency department complaining of acute generalized abdominal pain with fever, anorexia and vomiting started 2 days prior to presentation. A splenectomy was performed, with uneventful postsurgical follow-up. Wandering spleen is prone to torsion and infarction resulting in acute abdomen and a life-threatening condition with high mortality rate reaching 50%. We advise the investigation of any recurrent episodes of chronic pain keeping up within mind this diagnosis.
PubMed: 32082535
DOI: 10.1093/jscr/rjz378