The torsion of a wandering pelvic spleen: A case report

Abstract

A 15 years old patient was taken to the operative room for an explorative laparotomy due to abdominal pain and a pelvic spleen at preoperative computed tomography: was pointed out the absence of all splenic ligamentous attachments and short gastric vessels with a consequently dislocation of a bigger and congested spleen in the pelvis. This organ, wrapped in the omentum, was in a serious ischemic suffering due to a 720 degrees clock torsion around its exceptionally long pedicle (about 20 cm); besides was confirmed pancreatic body and tail ectopy. Following the derotation, the volume of the organ has decreased but became fixed in above norm dimensions. A total splenectomy was executed. Case presentationA 15 year old otherwise healthy Caucasian male student (52 kilograms of weight, 170 centimeters of height, no smoker, no drinking alcohol, not assuming medications with no significative family history) presented to the Emergency Department with a 24 hours abdominal pain and increase of his abdominal girth. The pain was noncontinuous, poorly localized, and was non-colicky and non-radiating in nature. There was no history of vomiting, bowel or urinary symptoms. Over the prior 2 months, he reported one other similar episode that had resolved spontaneously. He was afebrile and his vital signs were stable. Abdominal examination revealed marked diffuse abdominal tenderness and guarding. A large hypogastric abdominal mass was palpable. Urinalysis and urine culture were normal; he had a white cell count of 19.4 × 10 9 / L, hemoglobin 11.0 g/dL and platelets 410 × 10 9 /L). On abdominal sonography, no spleen could be demonstrated in the normal position; the left upper quadrant was filled with bowel loops. An enlarged spleen extending from lower-polar region of the left kidney to the pelvis was seen. A large hypoechoic area was seen, suggestive of infarction, with a streak of perisplenic fluid. Ultrasonography demonstrated no blood flow in the splenic vein and in the splenic artery. Subsequent contrast-enhanced CT scan also showed absence of the spleen in the left upper quadrant as well as an enlarged spleen in the left lumbar and iliac region. The splenic parenchyma showed poorly, inhomogenous enhancing areas suggestive of infarction. The splenic vein was dilatated and showed a non-enhancing filling defect near the hilum, indicating the presence of a thrombosis. The splenic vessels, pancreatic tail, and the surrounding fat formed a whorled appearance, supermedial to the splenic hilum, that was suggestive of torsion.The patient underwent exploratory laparotomy through a midline incision. This revealed the absence of all splenic ligamentous attachments and short gastric vessels with a consequently dislocation of a bigger and congested spleen in the pelvis. This organ, wrapped in the omentum, was in

Volvulus d’une rate voyageuse chez l’adulte : à propos d’un cas au CHU de Yopougon (Abidjan-Côte-d’Ivoire)

“…Cette anomalie est relativement fréquente chez l'enfant et la jeune fille [7][8][9]. La rate voyageuse peut être asymptomatique : sa découverte est alors fortuite lors de l'examen physique de l'abdomen ou au décours d'examens d'imagerie abdominale ou en préopératoire [10].…”

Splenic torsion: a case report

“…4 Acute, chronic or intermittent torsion of the spleen is the major complication of an abnormally mobile spleen. 5 The clinical presentation of torsion of the spleen is variable. Patients may be asymptomatic, complain of intermittent pain with torsion and spontaneous detorsion, or may present with an acute abdomen following torsion of the splenic pedicle with subsequent infarction.…”

“…Patients may be asymptomatic, complain of intermittent pain with torsion and spontaneous detorsion, or may present with an acute abdomen following torsion of the splenic pedicle with subsequent infarction. 5 Pain is due to capsular stretching from venous stasis and congestion. 4 Patients may complain of nausea, vomiting or fever, and may be peritonitic on examination.…”

Torsion of wandering spleen

“…Women, especially multiparous, are 13-fold more prone due to weakness of the abdominal wall and laxity of the ligaments [1]. Torsion in the wandering spleen can be acute, chronic or intermittent with varied clinical presentations [2]. Imaging helps in early diagnosis and treatment.…”

“…Imaging helps in early diagnosis and treatment. The treatment options include splenopexy (viable spleen) or splenectomy (non-viable spleen) [2]. Fig.…”