Torsion of Wandering Spleen and its adherence to the right ovary - An unusual cause of recurrent pain abdomen

Gulati, Malvika; Suman, Abhishek; Satyam, Satyam; Garg, Anju

doi:10.3941/jrcr.v14i7.3752

Cited by 9 publications

(9 citation statements)

References 12 publications

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“…In addition, many cases of wandering spleen with torsion are reported as a rare cause of acute or recurrent abdominal abdomen pain, even without infarction. [14][15][16][17] Our report also showed that real-time ultrasound is useful to identify symptomatic ectopic intramesenteric AS, revealing the precise topographic correspondence with the site of pain. Exact correspondence between the pain felt by the patient and the small nodule detected by ultrasound, as well as the pain evoked by the gentle compression with the sonographic probe just above the lesion, may be useful in the differential diagnosis.…”

Section: Discussionsupporting

confidence: 57%

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A case of symptomatic intramesenteric accessory spleen: The diagnostic role of contrast-enhanced ultrasound

2023

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Introduction: Accessory spleen is a congenital defect characterised by a separated ectopic splenic parenchyma usually located in the splenic hilum and the tail of the pancreas. It is present in about 10%–30% of the population and, generally, does not cause any symptoms. Case report: We report an interesting case of a woman with symptomatic intramesenteric accessory spleen detected and characterised by contrast-enhanced ultrasound. The patient experienced a long history of intermittent pain in the left upper abdomen. The diagnosis was confirmed by post-operative pathology examination. Discussion: Accessory spleen usually appears as a well-circumscribed ovoid mass, 1–3 cm in diameter, infrequently located in the mesentery. It may rarely become symptomatic because of complications. Diagnosis of this condition as a cause of abdominal is difficult and rarely has been made pre-operatively. Computed tomography and magnetic resonance imaging might help, but they should be performed with intravenous contrast injection, and they cannot provide direct evidence between the pain of the patient and the lesion. Conversely, real-time ultrasound can assess and diagnose the lesion showing the exact correspondence with abdominal pain of the patient. Furthermore, ultrasound and contrast-enhanced ultrasound are widely available, safe and relatively inexpensive. Conclusion: Apart from the rarity of this condition, this case report demonstrates the ability of ultrasound to localise the intramesenteric accessory spleen, assess the relationship between the lesion and the symptoms of the patient, and characterise the lesion.

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Section: Discussionsupporting

confidence: 57%

“…In addition, many cases of wandering spleen with torsion are reported as a rare cause of acute or recurrent abdominal abdomen pain, even without infarction. 14 –17…”

Section: Discussionmentioning

confidence: 99%

A case of symptomatic intramesenteric accessory spleen: The diagnostic role of contrast-enhanced ultrasound

2023

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“…As is implied by the term “wandering,” the spleen may be found in unusual anatomical locations, commonly in the lower abdominal or pelvic region, and present as a lower abdominal or pelvic mass ( 9 ). Its etiology is related to the embryological absence of attaching ligaments or laxity of splenic supporting ligaments ( 10 ). The absence of normal supporting ligaments indicates the congenital failure of the dorsal mesogastrium to fuse with the posterior abdominal wall during the second month of embryogenesis.…”

Section: Discussionmentioning

confidence: 99%

Splenectomy for Torsion of a Wandering Spleen in a Patient with Myeloproliferative Disease

et al. 2022

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We herein report a rare case of torsion of a wandering spleen in a patient with myeloproliferative disease. A 66-year-old Japanese woman presented to our hospital with abdominal pain and a fever. She had a medical history of polycythemia and secondary myelofibrosis. Abdominal enhanced computed tomography showed an enlarged spleen without enhancement in the lower pelvic region. The clinical diagnosis was severe torsion of a wandering spleen in a patient with myeloproliferative disease, necessitating surgical intervention. Splenectomy was performed after de-rotating to revascularize the spleen. After the operation, the platelet count gradually increased, and aspirin was administered to prevent thrombosis.

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“…Contrast CT can provide valuable and comprehensive information for diagnosis, including the location and size of the spleen, pedicle torsion (whirl sign), perfusion status, splenic vein/portal vein system thrombosis, and adjacent organ involvement (pancreatic tail torsion, stomach volvulus, compressing bladder or bowel, etc.) [10,20]. It's noteworthy that the whirl sign is highly specific and diagnostic for splenic pedicle torsion, which is twisted splenic pedicle intermingled with fat and/or distal pancreatic tissue, presenting as alternating circular radiodensity and radiolucency bands on contrast CT imaging [10].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction

Wang

Peng

et al. 2022

BMC Pediatr

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Background Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction. Methods From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized. Results There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4–170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient. Conclusions Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen.

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Torsion of Wandering Spleen and its adherence to the right ovary - An unusual cause of recurrent pain abdomen

Cited by 9 publications

References 12 publications

A case of symptomatic intramesenteric accessory spleen: The diagnostic role of contrast-enhanced ultrasound

A case of symptomatic intramesenteric accessory spleen: The diagnostic role of contrast-enhanced ultrasound

Splenectomy for Torsion of a Wandering Spleen in a Patient with Myeloproliferative Disease

Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction

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