Wandering spleen: a rare cause of mesenteroaxial gastric volvulus

Abstract

Gastric volvulus is a rare cause of acute abdomen in children. Usually it is associated with defects such as diaphragmatic hernia, hiatal hernia, eventration, and paralysis of the diaphragm. We report an extremely rare case presenting with acute intractable vomiting and abdominal distention. Passage of a nasogastric tube relieved the symptoms. A history of the ingestion of a large bolus of chewing gum and a suboptimal contrast study were misleading, and there was a delay in diagnosis of 3 days. Later, repeat upper GI fluoroscopy with contrast medium identified mesenteroaxial volvulus of the stomach. Exploratory laparotomy additionally revealed a wandering spleen. Derotation of the stomach with anterior gastropexy was performed. To our knowledge, wandering spleen in association with gastric volvulus has been mentioned only three times before in the literature.

Wandering spleen in children: multicenter retrospective study

“…On the other hand is a gastric volvulus (±associated to splenic torsion) [1,[17][18][19][20]. 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 proper surgical care [1].…”

Acute mesenteroaxial gastric volvulus and congenital diaphragmatic hernia

“…Excessive coughing may increase intragastric pressure, leading to strangulation of the stomach in a diaphragmatic defect. Other predisposing factors of AGV have been described in the literature, such as asplenia and wandering spleen [14][15][16]. Karande et al described a case of AGV in an 11-year-old boy with Ehlers-Danlos syndrome [6].…”

Eventration of the diaphragm and associations

“…Wandering spleen in association with gastric volvulus has been reported only 4 times earlier in the literature. 10 Fluoroscopy with contrast medium can be helpful in the diagnosis of gastric volvulus which may need derotation and gastropexy.…”