Wandering spleen with torsion: a rare cause of acute abdomen in a 14-year-old girl

Bairwa, Banwari Lal; Gupta, Savita; Singh, Aashik Kumar; Gupta, Pratima

doi:10.22551/2022.35.0902.10204

Cited by 6 publications

(4 citation statements)

References 18 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: 56%

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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: 56%

“…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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“…Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from normal anatomical position in the left hypochondrium to an ectopic site usually in the lower abdominal or the pelvic cavity [ 1 , 2 ]. Considered a rare clinical presentation with an overall incidence rate of less than 0.2%, it has been reported mostly in children within the first decade of life.…”

Section: Discussionmentioning

confidence: 99%

“…A laparoscopic splenopexy is the most practiced approach where splenic preservation is necessary (usually under 30 years of age) [ 14 ]. Splenectomy is a preferable choice in conditions of splenic infarction, hypersplenism, or splenomegaly [ 2 , 15 ]. Our patient presented with pedicle torsion and splenic infarction hence, a splenectomy was performed.…”

Section: Discussionmentioning

confidence: 99%

Splenic torsion mistaken for an ovarian cyst: a case report

Ahmed,

Iqbal,

Batool

et al. 2024

J Med Case Reports

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Background Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed. Case presentation A 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days. Conclusion Splenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.

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