Surgical Treatment of Patients with Wandering Spleen: Report of Six Cases with a review of the literature

Abstract

Wandering spleen, which is defined as a spleen without peritoneal attachments, is a rare disease and a delay in the clinical and/or radiological diagnosis may lead to splenic torsion, infarction, and necrosis. Owing to the physiologic importance of the spleen, especially in children, and the risk of postsplenectomy sepsis, early diagnosis and splenopexy are recommended. In the present article, we describe the results of our management of this rare problem on six patients, and we review all available literature from 1895 to 2005. Briefly, our technique includes flap creation from parietal peritoneum and settlement of spleen in the fossa splenica. Free edges of this flap are stitched to the stomach and the left end of transverse colon and the beginning of the descending colon. The body of the stomach was stitched to the abdominal wall to prevent gastric volvulus, while the fundus region was fixed to the diaphragm to support the spleen. Finally, an omental patch was stitched to the intact abdominal wall above the flap. In conclusion, the procedure of splenopexy without using mesh is considered to be a safe and curative modality for wandering spleen without imposing any undue risk of infection or foreign material reaction.

Laparoscopic Gastropexy for the Treatment of Wandering Spleen With or Without Gastric Volvulus

“…This is why it is also recommended, as a preventive measure, to perform a gastropexy on patients with a wandering spleen in order to avoid any risk of developing a gastric volvulus. (Spector & Chappell, 2000;Soleimani et al, 2007) -while limiting spleen manipulation that could be responsible for secondary splenic ischemia. (Fiquet-François et al, 2010) www.intechopen.com…”

Technique of Splenopexy for Wandering Spleen

“…1 This condition most commonly presents as splenic ischemia secondary to torsion of the vascular pedicle. 2 Thirty percent of cases are seen in children younger than 10 years, where the condition is congenital. In adults, it is more commonly an acquired condition.…”

“…It is hypothesized that excess estrogen of pregnancy causes laxity and eventual tearing of the splenic ligaments. 2 Wandering spleen accounts for less than 0.25% of splenectomies. 3 Splenectomy is the most common treatment compared with splenic salvage procedures.…”

“…4 Although splenic salvage is not always possible, there is an increased trend toward splenopexy, as splenectomy rates have decreased from 98% to 52% for this condition. 2 A variety of open and laparoscopic techniques for splenopexy are described. 4 Laparoscopic techniques mirror the same principals as open techniques, but laparoscopy has the advantage of less postoperative pain and disability plus decreased length of stay (LOS).…”

“…4 Another technique creates a peritoneal pocket along the lateral abdominal wall. 2,4 The spleen is subsequently placed within this pocket in the preperitoneal space, sutured closed around the splenic hilum, and secured by omentopexy. We report a technically simpler method of treating wandering spleen.…”