Wandering spleen with splenic torsion: Report of two cases

Virani, Peyman; Farbod, Ali; Niknam, Saman; Akhgari, Aisan

doi:10.1016/j.ijscr.2020.12.039

Cited by 10 publications

(15 citation statements)

References 16 publications

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“…Wandering spleen is predisposed to pedicle torsion and subsequent infarction, which is the most frequent complication and main reason of symptoms [7,13]. About 50% patients with wandering spleen are asymptomatic, but others may have acute, intermittent, or chronic symptoms due to torsion and spontaneous detorsion of the splenic pedicle [8,14,16]. The most common presentation was abdominal pain (93%) with a palpable abdominal mass, which was consistent with our results that all patients (6/6) presented abdominal pain/irritability, and half of them (3/6) had a palpable mass [8].…”

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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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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“…Most cases are attributed to be congenital in origin but acquired conditions like multiple pregnancies have also been incriminated. The splenic vessel's course within the pedicle, and therefore, torsion of the pedicle results in a partial or complete infarct of the spleen [5] . Torsion of a wandering spleen is diagnosed in about 0.2 -0.3% of patients who require splenectomy.…”

Section: Discussionmentioning

confidence: 99%

Wandering spleen with torsion presenting as a rare case of acute abdomen

Abebe

Teferi

Zeleke

2021

CSRC

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Wandering spleen is a rare clinical occurrence characterized by the absence of spleen in its normal anatomic place. Patients may present with acute abdomen, abdominal mass, and chronic abdominal pain. Prompt diagnosis and intervention are necessary. Here, we report a case of a woman who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. Keywords: Wandering spleen; torsion; splenectomy

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“…In this hypermobility the spleen is attached to the hilum only by a long vascular pedicle and the organ “wanders” in the lower abdomen or in the pelvis [1] , [2] , [3] . This condition is predisposed to complications, including the torsion of the splenic pedicle and partial or complete infarction of the spleen associated with splenic vein thrombosis [4] , [5] , [6] , [7] , [8] , [9] , [10] . The WS may be mistaken for an unidentified abdominal mass [1] , [2] , [6] , [10] , [11] , [12] .…”

Section: Introductionmentioning

confidence: 99%

“…As a result, computed tomography (CT) is the best imaging tool to make this diagnosis, although ultrasound may be used as well. The acute presentation with sudden onset of sharp abdominal pain is usually due to torsion of the splenic pedicle [2] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] .…”

Section: Introductionmentioning

confidence: 99%

“…In such circumstances tissue implants from the removed spleen on the greater omentum, to preserve at least part of the splenic functions, should be considered [14] . In the case of WS with no complications, the first-line treatment is elective laparoscopic splenopexy, performed in different techniques, including or not the use of a mesh [1] , [6] , [9] , [10] , [15] , [16] . Elective splenectomy for complicated WS is recommended when the spleen parenchyma is too damaged to recover from several ischemic events, or for the spleen dimension [7] , [11] , [12] .…”

Section: Introductionmentioning

confidence: 99%

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Wandering splenomegaly reduction after splenopexy

Petroianu

Sabino

2021

International Journal of Surgery Case Reports

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Introduction and importance A wandering spleen is characterized by excessive splenic mobility due to the laxity of its ligaments, which leads to spleen migration and its long mobile vascular pedicle is liable to torsion. The purpose of this paper was to present a wandering splenomegaly reduction after splenic detorsion and splenopexy. Case presentation A 14-year-old boy presented a symptomatic visible pelvic wandering splenomegaly with torsion of the splenic pedicle. He was submitted to laparotomy, detorsion of the spleen, and splenopexy to the left diaphragm and surrounded peritoneum. The patient had an uneventful follow-up and was discharged from the hospital on the second postoperative day. All laboratory exams went to normal. The size of the spleen reduced from the 22 × 16 × 13 cm before the treatment to 14 × 12 × 10 cm after the surgical procedure. Clinical discussion The most relevant aspect of this communication is the reduction of the huge splenomegaly to a normal size spleen after detorsion of the splenic vessels and splenopexy to the left diaphragm. Reduction of the splenic size is well-known after distal splenorenal shunt, but this is the first publication of a spontaneous splenic size reduction after treating a congestive wandering splenomegaly by detorsion of the spleen pedicle. Conclusion Ectopic congestive splenomegaly due to the splenic pedicle rotation is adequately treated by splenic detorsion and splenopexy in its proper subdiaphragmatic site, which reduces the splenic size to normal.

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Wandering spleen with splenic torsion: Report of two cases

Cited by 10 publications

References 16 publications

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

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

Wandering spleen with torsion presenting as a rare case of acute abdomen

Wandering splenomegaly reduction after splenopexy

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