Laparoscopic splenectomy for a simultaneous wandering spleen along with an ectopic accessory spleen. Case report and review of the literature

Abstract

HighlightsWe report a case of a simultaneous condition of wandering spleen along with an ectopic wandering spleen.The coexistence of these two rare conditions is peculiar.The age of the patient is uncommon (usually range 20–40 years).We report on a minimally invasive surgical approach for the treatment of these conditions.In medical literature is in our knowledge the first experience.

Diagnosis and Management’s Distinctive Features of an Ectopic Spleen in a Precarious Country

“…Ectopic spleen is rare, less than 0.5% of several large series splenectomies [1,2]. It exists at any age, with predominance at male children under 10 years old, at women during genital activity period, between 20 and 40 years of age [1,6], at the third decade of life, and at patient without particular medical history [1,4,5,7,8]. Only intraperitoneal localization is described, with hypogastric or pelvic predilection [4].…”

“…Indian team recommends splenectomy only in case of infarction [1]. Italian team reports an uneventful postoperative recovery after laparoscopic way splenectomy for a combined wandering and accessory spleens case, till patient releasing after 6 days [6]. Peduncle's ligations by endoclips, arterial before veinous, were followed by extraction through a pfannenstil incision [6].…”

Laparoscopic splenectomy for a wandering spleen with resultant splenomegaly and gastric varices

“…6 In this patient, she presented with intermittent bouts of abdominal pain, likely secondary to intermittent torsion with subsequent detorsion of the wandering spleen. 6,7 With prolonged chronic torsion, splenic vein occlusion occurs, with resultant gastric varices. Wandering spleens tend to have a female predisposition, with majority of patients presenting in late adolescent to mid-adulthood.…”

“…1,2 During the fifth to sixth week of embryological development, a failure of fusion of the dorsal mesogastrium results in an abnormally long splenic vascular pedicle. 6 The lack of fusion also results in lack of fixation of the spleen and formation of the splenorenal and gastrosplenic ligaments, thus allowing the spleen to be extremely mobile in the abdominal cavity. 6 In this patient, she presented with intermittent bouts of abdominal pain, likely secondary to intermittent torsion with subsequent detorsion of the wandering spleen.…”

“…6 The lack of fusion also results in lack of fixation of the spleen and formation of the splenorenal and gastrosplenic ligaments, thus allowing the spleen to be extremely mobile in the abdominal cavity. 6 In this patient, she presented with intermittent bouts of abdominal pain, likely secondary to intermittent torsion with subsequent detorsion of the wandering spleen. 6,7 With prolonged chronic torsion, splenic vein occlusion occurs, with resultant gastric varices.…”