Laparoscopic Gastropexy for the Treatment of Gastric Volvulus Associated with Wandering Spleen

Abstract

A 2.5-year-old boy was referred to the emergency room for a sudden onset of diffuse and increasing abdominal pain with lethargy, abdominal distension, and vomiting, all in the past 24 hours. A plain abdominal X-ray showed gastric distension. Two liters of gastric contents were evacuated by suction. The abdominal sonogram showed an unusual position of the spleen in the left-lower quadrant, with no splenic ischemia. The diagnosis of gastric volvulus associated with a wandering spleen was then evoked. Laparoscopic exploration revealed a nonischemic spleen, absence of normal supporting ligaments for the spleen, and gastric distension with flaccid gastric walls. The spleen was then easily moved in the left-under quadrant. A parietal peritoneal posterolateral incision was made, opposite the large gastric curve, up to the diaphragm (7 cm). This delimitated a sharp demarcation zone between the two edges of the incised peritoneum. The stomach was fixed to the peritoneal incision, covering and anchoring the spleen in a good position. Recovery was uneventful, and an abdominal sonogram performed 4 years after the surgery shows a viable spleen in its correct location. The rarity of gastric volvulus associated with a wandering spleen and its fast clinical improvement with medical treatment often delays the diagnosis and the surgical treatment. Laparoscopy in this case has a dual relevance: diagnosis and therapeutic management (splenectomy or gastropexy). Laparoscopic gastropexy for the treatment of gastric volvulus associated with a wandering spleen is an easy procedure and combines the advantages of all the surgical techniques previously described.

Wandering spleen in children: multicenter retrospective study

“…In the literature, we find isolated case reports but rarely studies on larger populations [1][2][3][4][5][6].…”

Laparoscopic Gastropexy for the Treatment of Wandering Spleen With or Without Gastric Volvulus

“…(S. Zarrintan et al, 2007) Ghazeeri et al (Ghazeeri et al, 2010) reported the case of splenic torsion on wandering spleen in a pregnant woman in her twelfth week of twin pregnancy. This pathology is also found in children seemingly affecting more boys than girls (Allen & Andrews, 1989;François-Fiquet et al, 2009;Fiquet-François et al, 2010). This condition can occur very early on as seen in neonatal cases (Balliu et al, 2004;Fiquet-François et al, 2010, Arleo et al, 2010.…”

“…In some cases patients can be in a real state of shock. Gastric volvulus associated to wandering spleen is a rare condition, and its quick clinical improvement with a simple medical treatment often delays the diagnosis and access to proper surgical care (Fiquet-François et al, 2010;François-Fiquet 2009;Spector & Chappell, 2000;Qazi & Awadalla, 2004). The semiological difficulty is quite real when faced with complex clinical pictures associating gastric volvulus, wandering spleen and even in some cases a diaphragmatic hernia (Liu & Lau, 2007).…”

“…Some children were even hospitalized several times before making a proper diagnosis. This is mostly due to the quick clinical improvement when the child was lying down (Fiquet-François et al, 2010;François-Fiquet et al, 2009). The chronic clinical picture once again underlines the difficulty in making a proper diagnosis when faced with an atypical clinical picture.…”

“…In this context, laparoscopic surgery is the procedure of choice. It allows for an etiological diagnosis, a good evaluation of the surgical situation while offering several therapeutic possibilities: splenectomy (Carmona et al, 2010), splenopexy (Hirose et al, 1998;Kleiner et al, 2006), gastropexy (François-Fiquet et al, 2009;Fiquet-François et al, 2010) or even a combination of several techniques such as gastropexy and splenopexy (Okazaki et al, 2010) The choice for classic open surgery or laparoscopic surgery varies according to the different surgical teams. When there is no history of abdominal surgery, laparoscopic procedure seems to be the procedure of choice.…”