Surgical Approach of Wandering Spleen in Infants and Children: A Systematic Review

Ganarin, Alba; Leon, Francesco Fascetti; Pergola, Enrico La; Gamba, Piergiorgio

doi:10.1089/lap.2020.0759

Cited by 10 publications

(7 citation statements)

References 128 publications

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“…It's generally considered a congenital abnormality in children and rarely encountered [5,12,13]. The normal spleen is located at left hypochondrium and fixed to the retroperitoneum by some main splenic suspensory ligaments, namely gastrosplenic, splenorenal, splenocolic, and splenophrenic ligaments [14,15]. During embryogenesis, failure of fusion of the dorsal mesogastrium to the posterior abdominal wall causes absence of these suspensory ligaments and elongation of splenic vascular pedicle, leading to wandering spleen [11,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…The normal spleen is located at left hypochondrium and fixed to the retroperitoneum by some main splenic suspensory ligaments, namely gastrosplenic, splenorenal, splenocolic, and splenophrenic ligaments [14,15]. During embryogenesis, failure of fusion of the dorsal mesogastrium to the posterior abdominal wall causes absence of these suspensory ligaments and elongation of splenic vascular pedicle, leading to wandering spleen [11,14,15]. In children the reported female to male ratio is 2.4:1, and the female predominance is not so obvious as in adults (7:1) [4].…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Wang

Peng

et al. 2022

BMC Pediatr

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“…In a systematic review, splenic torsion was diagnosed in 56% of pediatric patients with wandering spleen. 6 Torsion usually occurs counterclockwise, leads to chronic stasis in splenic vein, increased backpressure in splenic vein, parenchymal congestion, splenomegaly, and hypersplenism. Impaired venous return results in retrograde filling of short gastric and left gastroepiploic veins.…”

Section: Discussionmentioning

confidence: 99%

Torsion of a Wandering Spleen Involving the Pancreatic Tail and Splenic Flexure and Isolated Left-Sided Portal Hypertension due to Chronic Splenic Vein Thrombosis

Kachare

Jaisinghani

2022

Journal of Gastrointestinal and Abdominal Radiology

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Wandering spleen is a rare entity, wherein the spleen is attached only by an elongated vascular pedicle, predisposing it to complications like hilar torsion, infarction, rupture, etc. Pancreatic volvulus is another very rare anomaly, with isolated case reports described in association with wandering spleen. The presentation varies from asymptomatic lump (stimulating a mass) to acute abdomen (due to torsion). We present a case of 26-year-old female patient who complained of pain in abdomen, and was radiologically diagnosed and surgically confirmed to have a torsion of wandering spleen with involvement of pancreatic tail and splenic flexure. Few cases with associated finding of gastric volvulus and sigmoid volvulus have been described previously. Involvement of descending colon in a 9-year-old child has been reported. However, to the authors' knowledge, this is the first case report describing the combination of wandering spleen with splenic flexure and pancreatic tail involvement in an adult.

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“…Spleen preservation is strongly recommended in clinical practice. In the absence of an indication of splenic infarction, de-torsion of the splenic pedicle and splenopexy are suitable surgical options, with the laparoscopic approach being encouraged [14].…”

Section: Discussionmentioning

confidence: 99%

Wandering Spleen: A Rare Case of an Adnexal Lesion

Vlastarakos

Rouvali

Giourga

et al. 2021

Cureus

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The wandering spleen (WS) is a rare condition in which the spleen is not found in its usual location in the left hypochondrium but is positioned in the lower abdomen or the pelvis. This is a case of a 21-year-old woman who presented with chronic, intermittent, and subtle pain in the left lower quadrant of her abdomen. After clinical examination and ultrasound evaluation, an adnexal lesion was detected in the left lumbar area, and no splenic tissue was found in the left hypochondrium. The wandering spleen should be included in the differential diagnosis when encountering a patient with non-typical or acute abdominal pain. Accurate diagnostic evaluation can be performed with low-cost imaging modalities such as Doppler ultrasound.

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Surgical Approach of Wandering Spleen in Infants and Children: A Systematic Review

Cited by 10 publications

References 128 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

Torsion of a Wandering Spleen Involving the Pancreatic Tail and Splenic Flexure and Isolated Left-Sided Portal Hypertension due to Chronic Splenic Vein Thrombosis

Wandering Spleen: A Rare Case of an Adnexal Lesion

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