Enlarged wandering spleen treated with hemisplenectomy and fixation of the residual spleen

Esposito, Ciro; Settimi, Alessandro; Centonze, Antonella; Damiano, Rocco; Maglio, P.; Esposito, Giovanni

doi:10.1007/s00383-005-1403-z

Cited by 10 publications

(5 citation statements)

References 7 publications

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“…Its etiology may be congenital or acquired and it is associated with splenic torsion or infarction, [1][2][3][4] which can result in an abdominal emergency if acute torsion of the splenic pedicle occurs. Mild torsion or vascular kinking can manifest as an abdominal mass and chronic or intermittent abdominal pain caused by splenic congestion and capsular tension.…”

Section: Introductionmentioning

confidence: 99%

Splenic Autotransplantation for a Congested and Enlarged Wandering Spleen with Torsion: Report of a Case

et al. 2006

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In children with diseases of the spleen, every effort should be made to preserve the organ, to prevent severe infections postsplenectomy. We report the case of a 7-year-old girl with torsion of a wandering spleen who we treated by autotransplantation of splenic tissues following splenectomy, when fixation of the enlarged spleen seemed impossible. Spleen scintigraphy showed uptake in the regenerating splenic tissues 9 months after surgery, and evidence of an increase in the size of the tissues 23 months after surgery. Howell-Jolly bodies had disappeared by 16 months after surgery. These findings suggested that the transplanted splenic tissues were resuming splenic functions. Based on our experience with this case, we conclude that autotransplantation after splenectomy is a treatment option for wandering spleen with torsion when fixation seems difficult because of splenic congestion and enlargement.

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Section: Introductionmentioning

confidence: 99%

Splenic Autotransplantation for a Congested and Enlarged Wandering Spleen with Torsion: Report of a Case

et al. 2006

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“…Umeda et al introduced a three-incision retroperitoneal pouch technique to fix a large spleen [32]. Fonseca et al and Esposito et al used a combined technique of partial splenectomy and splenopexy, which can be adopted in case of a partial infarcted spleen or a large spleen [37,38]. Goyal et al performed a salvage splenopexy for a patchy reperfused spleen after detorsion, which was proved viable after 4 months by biopsy [39].…”

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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“…Of these cases, 40 included details on the operative management, the majority being splenopexy. One patient was operatively managed with an open partial splenectomy to remove only the infarcted area of splenic tissue followed by splenopexy for the viable portion of the spleen [14]. Within the patients who underwent splenopexy, three patients underwent splenopexy and gastropexy for gastric volvulus (two were performed by laparotomy and one by laparoscopy) [15-17].…”

Section: Discussionmentioning

confidence: 99%

“…Splenic cysts were noted in two cases thus requiring splenopexy and cystectomy, both performed as open procedures [18,19]. For patients that had viable spleens intraoperatively and underwent splenopexy, six had mesh placed to secure the spleen (four used vicryl mesh, one reported use of non-absorbable mesh, and one had polypropylene) [14,19-22]. The remainder of splenopexies used adjacent tissue from the diaphragm, anterior abdominal wall, or peritoneum to create pouches for the spleen.…”

Section: Discussionmentioning

confidence: 99%

Non-operative management of a rare diagnosis of splenic torsion in a child with a history of giant omphalocele: a case report and literature review

et al. 2014

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BackgroundSplenic torsion is rare and as a result the appropriate management is unclear. While there has been a shift towards splenectomy and laparoscopic splenopexy, we present a successful case of non-operative management of splenic torsion in a patient with a history of a giant omphalocele.Case presentationA 3 year-old female presented with a three-day history of abdominal pain, fever and non-bloody emesis three and a half years after repair of her giant omphalocele. Abdominal radiographs and ultrasound demonstrated migration of the spleen and a subsequent computerized tomography scan confirmed splenic torsion and an infarcted spleen. Given her late presentation, she was successfully managed with observation, analgesia, immunization against capsulated organisms and daily penicillin prophylaxis with excellent outcome at 19 months follow-up. A review of the literature revealed that splenic torsion is rarely managed non-operatively. Rarer still is the occurrence of splenic torsion following a history of omphalocele.ConclusionAlthough rare, splenic torsion should be considered in a child with a history of omphalocele presenting with abdominal pain. Non-operative management of an infarcted spleen can be a safe treatment option to avoid surgery in complex patients.

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Enlarged wandering spleen treated with hemisplenectomy and fixation of the residual spleen

Cited by 10 publications

References 7 publications

Splenic Autotransplantation for a Congested and Enlarged Wandering Spleen with Torsion: Report of a Case

Splenic Autotransplantation for a Congested and Enlarged Wandering Spleen with Torsion: Report of a Case

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

Non-operative management of a rare diagnosis of splenic torsion in a child with a history of giant omphalocele: a case report and literature review

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