An Unusual Case of Acute Pancreatitis and Gastric Outlet Obstruction Associated with Wandering Spleen Treated by Laparoscopic Splenopexy

Abstract

Wandering spleen (WS) is an uncommon condition, usually asymptomatic, often recognized as an incidental finding. When symptoms occur, they can vary, although acute abdominal pain is the most common presentation in the pediatric population. In some cases, WS can become a dangerous condition because of the risk of splenic ischemia from persistent pedicle torsion. We describe a case of WS in a 3-year-old boy presenting with vomiting, abdominal swelling, and acute pancreatitis; the diagnosis was obtained by ultrasound and computed tomography. Laparoscopic splenopexy was successfully performed through an extraperitoneal pocket and a Vicryl mesh. To the best of our knowledge, the combination of gastric outlet obstruction and acute pancreatitis has never been reported as presenting symptoms of WS.

Successful treatment of floating splenic volvulus: Two case reports and a literature review

“…The postoperative complications of splenic fixation mainly include splenic ischemia, infarction and recurrent torsion. Magno et al [ 33 ] retrospectively analyzed 125 cases of patients who underwent splenectomy and splenic fixation, and found that the incidence of postoperative complications was about 5%, including splenic infarction, recurrent volvulus, splenic ischemia, pneumothorax[ 33 ]. Fiquet-Francois et al [ 34 ] retrospectively analyzed 14 cases of patients who underwent splenic vagrant surgery in multicenter.…”

Is laparoscopic approach for wandering spleen in children an option?

“…[9] Not all patients with gastric outlet obstruction required gastropexies. A study by Magno et al [10] described the symptomatology subsided after nasogastric tube placement and no gastropexy was performed.…”

“…After derotation and splenopexy, there is no reported evidence of pancreatic injury or complication. [1011]…”

Laparoscopic Transperitoneal Left Adrenalectomy and Wandering Spleen Risk

“…Bowel obstruction may occur because of the compression of abdominal organs 19 ; enuresis and hydronephrosis may be other consequences, 20 as well as gastric fundal varices, 21 mesenteric varices, 22 and acute pancreatitis. 23 The torsion of the vascular pedicle may result in splenomegaly. The progressive splenic enlargement can lead to rare splenic ruptures and to possible spontaneous massive hemoperitoneum.…”