Emergency laparoscopic splenectomy for torsion of wandering spleen in a geriatric patient: A case report

Nastiti, Novia Ayuning; Niam, Muhammad S; Khoo, Phong Jhiew

doi:10.1016/j.ijscr.2019.07.021

Cited by 23 publications

(22 citation statements)

References 16 publications

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“…[ 8 ] After the first decade, WS predominantly occurs among females compared to males, with a ratio of 7:1. [ 9 ] However, within the younger occurring peak of WS, toddler (aged 1–3 years) WS cases are unusual. Among the known WS patients, only 8 toddler WS cases, including the present one, have been reported (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…[ 15 ] This condition is multifactorial, and the etiologies are broadly divided into congenital anomalies and acquired conditions. [ 9 ] Generally, hypermobile spleen mainly results due to the absence or excessive laxity of suspensory ligaments; these ligaments include the gastrosplenic, splenorenal, splenocolic, splenophrenic, and pancreatico-splenic ligaments. [ 9 ] Among these ligaments, the gastrosplenic and splenorenal ligaments attach the spleen to the stomach and posterior abdominal wall, respectively, and the splenocolic and splenophrenic ligaments support the spleen inferiorly, which are relatively critical in fixing the spleen in the splenic fossa.…”

Section: Discussionmentioning

confidence: 99%

“…[ 9 ] Generally, hypermobile spleen mainly results due to the absence or excessive laxity of suspensory ligaments; these ligaments include the gastrosplenic, splenorenal, splenocolic, splenophrenic, and pancreatico-splenic ligaments. [ 9 ] Among these ligaments, the gastrosplenic and splenorenal ligaments attach the spleen to the stomach and posterior abdominal wall, respectively, and the splenocolic and splenophrenic ligaments support the spleen inferiorly, which are relatively critical in fixing the spleen in the splenic fossa. [ 4 ] Congenital WS is mainly due to the failure of complete fusion of the mesogastrium and posterior abdominal wall during the second month of pregnancy, which may result in the absence or maldevelopment of one or more ligaments, and cause splenic hypermobility.…”

Section: Discussionmentioning

confidence: 99%

“…According to the reported cases, trauma, multiparity, connective tissue disorders, renal agenesis, and hormonal changes after pregnancy might increase splenic mobility. [ 9 ] In pediatrics, congenital maldevelopment and abnormal fixation are the most common causes of WS. [ 4 ] Acquired WS in pediatric patients is reported as being associated with multiple conditions, such as renal agenesis, immunoglobulin deficiency, infectious mononucleosis, malaria, Gaucher disease, Hodgkin lymphoma, and DiGeorge syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…[ 20 ] Most adult patients with WS are asymptomatic and are incidentally diagnosed during physical examination, with a firm mobile abdominal mass with characteristic palpable “notched borders,” or via imaging examination for other purposes. [ 9 , 21 ] Whereas pediatric patients usually present with acute abdominal pain, when complicated by splenic torsion, the pain severity often depends on the torsion degree. In pediatric patients, mild torsion may present as chronic abdominal pain due to splenic congestion; moderate torsion usually presents with intermittent pain, which is caused by torsion and detorsion of the vascular pedicle; severe torsion always leads to splenic infarction and results in acute abdomen.…”

Section: Discussionmentioning

confidence: 99%

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Wandering spleen with splenic torsion in a toddler

Wang¹,

Qiang²,

Huang

et al. 2020

Medicine

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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.

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Section: Discussionmentioning

confidence: 99%