Torsion of wandering spleen involving the pancreatic tail

Colombo, Francesco; D'Amore, Pierluigi; Crespi, Michele; Sampietro, Gianluca; Foschi, Diego

doi:10.1016/j.amsu.2019.12.001

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…Symptomatic patients may have different clinical signs and symptoms as reported in the literature, e.g. acute, intermittent, or chronic pain because of torsion and detorsion of the splenic pedicle, vomiting, abdominal distention, constipation, palpable, movable mass in the abdomen or pelvic same like in our case or other signs and symptoms of an acute abdomen may present [ 2 – 4 , 13 – 15 ]. The symptoms may be related to the kind of complication patients present with; for example, if a patient presents with a wandering spleen leading to intestinal obstruction, the patient may have pain, abdominal distention, vomiting, and constipation.…”

Section: Discussionmentioning

confidence: 92%

Torsion of the wandering spleen as an abdominal emergency: a case report

Masroor

Sarwari

2021

BMC Surg

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Background Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium. Case presentation A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of the wandering spleen’s pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully. Conclusion Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.

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Section: Discussionmentioning

confidence: 92%

Torsion of the wandering spleen as an abdominal emergency: a case report

Masroor

Sarwari

2021

BMC Surg

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“…The failure of fusion of dorsal mesogastrium to the retroperitoneum may also cause the pancreatic tail becoming intraperitoneal, instead of retroperitoneal, which can be involved in splenic pedicle torsion [10]. Usually after detorsion and splenopexy or splenectomy, the pancreatic tail can be replaced with no further complications [6,11]. Distal pancreatectomy should only be reserved for cases with pancreatic tail necrosis due to torsion.…”

Section: Discussionmentioning

confidence: 99%

“…About one third of all patients were children, and in adults it mainly affects women of reproductive age (20-40 years old) [4,5]. Early diagnosis and timely surgical intervention are important to preserve the spleen, especially in children [6,7]. In this rare entity, no preoperative predictive factor for splenic infarction has been proposed so far.…”

Section: Introductionmentioning

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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“…Torsion of a wandering spleen is diagnosed in about 0.2 -0.3% of patients who require splenectomy. The clinical presentation of the wandering spleen may be variable, from an asymptomatic patient to one with mild abdominal pain, signs of acute abdomen with or without peritonitis [2,6] . Ultrasound imaging with duplex scanning can be used as an initial mode of imaging which can show the position of the wandering spleen with concomitant replacement of bowel in the left upper quadrant.…”

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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Torsion of wandering spleen involving the pancreatic tail

Cited by 11 publications

References 8 publications

Torsion of the wandering spleen as an abdominal emergency: a case report

Torsion of the wandering spleen as an abdominal emergency: a case report

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

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