Torsion of Wandering Spleen with Infarction

Khan, Dawar; Khandwala, Kumail; Abbasi, Summar-Un-Nisa; Khan, Sarim D; Raza, Rabail

doi:10.7759/cureus.3177

Cited by 12 publications

(21 citation statements)

References 11 publications

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“…[ 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%

“…In abdominal ultrasonography, during a condition of WS, the spleen is not visualized in the splenic fossa, and a mass appears in the abdomen or pelvic cavity, which demonstrates a heterogeneous or hypoechoic echotexture with decreased hilar color flow on Doppler. [ 21 ] Beside the diagnosis of WS, the viability of the spleen, involvement of other nearby organs, and torsion degree, which can be defined by identification of the whirl sign and the hilar color Doppler flow, are able to be assessed via ultrasonography. [ 6 ] Abdominal CT scan is another common examination that is routinely performed to aid the diagnosis and assessment of WS.…”

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%

Section: Discussionmentioning

confidence: 99%

Wandering spleen with splenic torsion in a toddler

Wang¹,

Qiang²,

Huang

et al. 2020

Medicine

View full text Add to dashboard Cite

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“…According the anatomopathological point of view, the wandering spleen could be located in the different quadrants of the abdomen: hypogastric [6,10], epigastric [11], periumbilical [5], left iliac fossa [12], right flank [3]. In our case, the spleen is located in the left flank.…”

Section: Case Presentationmentioning

confidence: 84%

“…The torsion of vascular pedicle of spleen could observed on CT-scan [9]. According to Khan's study, CTscan is the best method of choice for diagnosis when splenic torsion is suspected [10].…”

Section: Case Presentationmentioning

confidence: 99%

Torsion of the Vascular Pedicle of A Wandering Spleen: An Unusual Cause of Intestinal Strangulation

et al. 2021

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Ectopic spleen is a rare splenic malformation. Apart from torsion of the vascular pedicle, a common complication, an ectopic spleen could be responsible of an acute intestinal obstruction. We report a case of an 8-year-old girl who presented an acute abdomen, following of the transverse colon strangulation by the torsion of the vascular pedicle of a wandering spleen. The patients benefited a surgical opening into the abdomen who has been confirmed the diagnosis and made a detorsion of the vascular pedicle of spleen with splenopexy.The interest of this case report lies on the rarity of a wandering spleen and on the unusual situation of transverse colon strangulation by the vascular pedicle of spleen.

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“…Previous reports have described splenic torsion in conjunction with a wandering spleen [7–9] or an accessory spleen [10, 11]. However, few reports have described splenic torsion in the context of polysplenia.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic splenectomy for polysplenia with splenic torsion: a case report

et al. 2019

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Background: Polysplenia refers to the presence of two or more equal-sized spleens. Very rarely, one of the multiple spleens may develop torsion and infarction. Case presentation: A 21-year-old woman presented with left upper quadrant pain, the cause of which could not be diagnosed. She returned to our hospital, 2 days later, without any pain improvement. Enhanced computed tomography showed splenic infarction and polysplenia. Initially, we could not identify the cause of the infarction and started conservative therapy, which did not result in any improvement. Hence, we performed a splenectomy, after securing informed consent. Because the patient was a young woman, we opted for a laparoscopic approach. During surgery, we identified the cause of the infarction as spleen pedicle torsion; the infarcted spleen was excised using an automated suturing device. We completed the laparoscopic surgery without converting it to an open laparotomy, and the patient was discharged 4 days later. This was a rare case of polysplenia with splenic torsion. Conclusion: Laparoscopic splenectomy is minimally invasive and has cosmetic advantages. Thus, this approach may be considered as a treatment option for this condition.

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Torsion of Wandering Spleen with Infarction

Cited by 12 publications

References 11 publications

Wandering spleen with splenic torsion in a toddler

Wandering spleen with splenic torsion in a toddler

Torsion of the Vascular Pedicle of A Wandering Spleen: An Unusual Cause of Intestinal Strangulation

Laparoscopic splenectomy for polysplenia with splenic torsion: a case report

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