Acute gastric volvulus associated with wandering spleen in an adult treated laparoscopically after endoscopic reduction: a case report

Abstract

A 43-year-old female was referred to our hospital for sudden onset of abdominal pain, fullness, and vomiting. Physical examination revealed abdominal distension with mild epigastric tenderness. Abdominal radiography showed massive gastric distension and plain computed tomography (CT) a markedly enlarged stomach filled with gas and fluid. A large volume of gastric contents was suctioned out via a nasogastric (NG) tube. Contrast-enhanced CT showed a grossly distended stomach with displacement of the antrum above the gastroesophageal junction, and the spleen was dislocated inferiorly. Upper gastrointestinal (GI) series showed the greater curvature to be elevated and the gastric fundus to be lower than normal. Acute mesenteroaxial gastric volvulus was diagnosed. GI endoscopy showed a distortion of the gastric anatomy with difficulty intubating the pylorus. Various endoscopic maneuvers were required to reposition the stomach, and the symptoms showed immediate and complete solution. GI fluoroscopy was performed 3 days later. Initially, most of the contrast medium accumulated in the fundus, which was drawn prominently downward, and then began flowing into the duodenum with anteflexion. Elective laparoscopic surgery was performed 1 month later. The stomach was in its normal position, but the fundus was folded posteroinferiorly. The spleen attached to the fundus was normal in size but extremely mobile. We diagnosed a wandering spleen based on the operative findings. Gastropexy was performed for the treatment of gastric volvulus and wandering spleen. The patient remained asymptomatic, and there was no evidence of recurrence during a follow-up period of 24 months. This report describes a rare adult case of acute gastric volvulus associated with wandering spleen. Because delay in treatment can result in lethal complications, it is critical to provide a prompt and correct diagnosis and surgical intervention. We advocate laparoscopic surgery after endoscopic reduction because it is a safe and effective procedure with lower invasiveness.

Torsion of Wandering Spleen 9 Years After Gastric Volvulus: Effect of Multiparity?

“…The coexistence of these two diseases has been described only four times in adults. [5][6][7][8] Those cases were reported to have both pathologies at the time of diagnosis. Omata et al [5] and Lianos et al [7] made a diagnosis of wandering spleen during surgical intervention, while other authors [6,8] detected it on CT scan preoperatively applied.…”

“…[5][6][7][8] Those cases were reported to have both pathologies at the time of diagnosis. Omata et al [5] and Lianos et al [7] made a diagnosis of wandering spleen during surgical intervention, while other authors [6,8] detected it on CT scan preoperatively applied. All authors [5][6][7] except for one [8] performed gastropexy without splenopexy or splenectomy.…”

“…Omata et al [5] and Lianos et al [7] made a diagnosis of wandering spleen during surgical intervention, while other authors [6,8] detected it on CT scan preoperatively applied. All authors [5][6][7] except for one [8] performed gastropexy without splenopexy or splenectomy. Splenic torsion to be constrained splenectomy was not noted in those case reports, and the authors advocated gastric fixation would prevent splenic hypermobility.…”

Gastric Volvulus – A Rare Entity

“…Complications are higher in Organoaxial, the most common type of volvulus. Overall mortality is reduced with better radiological studies and early recognition of the condition [26].…”

Volvulus of a wandering pelvic spleen: CT diagnosis with 3D reformatted illustration

“…WS is an uncommon congenital or acquired condition related to the absence or laxity of the splenic ligaments; it is detected fortuitously or in the diagnostic workup of an acute abdominal pain related to its pedicle torsion 1. WS has also been described in association with gastric volvulus 2. It is reported in less than 2% of splenectomy and concerns children under 10 years and women between 20 and 40 years (childbearing age).…”