Wandering spleen: a rare complication of sleeve gastrectomy

Abstract

The spleen is an intraperitoneal organ typically located in the left upper quadrant. Ectopic (‘wandering’) spleen refers to the displacement of the spleen from its normal anatomical location to another region in the abdominal cavity or pelvis. It’s a relatively rare condition with no clear aetiology. We present, here, a case of a wandering spleen following sleeve gastrectomy in a 23-year-old female patient, whose spleen, prior to this event, was demonstrated by imaging in a normal anatomical position. A splenectomy was performed, and after an uneventful postoperative period, the patient was discharged. No similar case description was found in the relevant medical literature. Possible causes and decision-making process are discussed. We conclude that the wandering spleen phenomenon should be considered in the differential diagnosis of patients presenting with abdominal pain and new abdominal mass following sleeve gastrectomy.

Surgical Management of a Volvulus of a Wandering Spleen Associated with a Volvulus of the Small Intestine

“…Splenomegaly has also been proposed as a possible etiology; however, in most patients with WS, the spleen demonstrates no anomalies [18]. WS postsleeve gastrectomy has also been described [19].…”

‘Wandering spleen with acute torsion’ : a rare indication for splenectomy in an adult, complicated by postoperative splanchnic venous thrombosis and intestinal gangrene

“…It is held in its normal position in the left upper quadrant of the abdomen by four ligaments, namely, gastrosplenic, phrenicosplenic, splenic-colic and lienorenal. The absence of laxity in splenic ligaments will lead to a hypermobile spleen, which may be ectopic in position and attached only by an elongated vascular pedicle 9 10. Congenital absence or laxity of the ligaments is due to the failure of the dorsal mesogastrium to fuse with the posterior abdominal wall during the second month of embryogenesis 3 4 11.…”

“…Congenital absence or laxity of the ligaments is due to the failure of the dorsal mesogastrium to fuse with the posterior abdominal wall during the second month of embryogenesis 3 4 11. Laxity of ligaments can also be acquired secondary to trauma, and splenomegaly due to malaria and haematological disorders such as hereditary spherocytosis, thalassaemia and lymphomas or due to the hormonal effects of pregnancy 4 5 9. WS is prone to torsion and infarction 1 4.…”

“…WS is also reported to develop after Nissen’s fundoplication and sleeve gastrectomy 9 14. The mechanism is postoperative acquired hypermobility, resulting from the division of the gastrosplenic ligament.…”

“…It can also present with complications such as splenic vascular thrombosis leading to infarction, splenic cyst or abscess, left-sided portal hypertension leading to gastric varices, and splenic haemorrhage or spontaneous rupture. The torsion may also involve the adjacent organs, leading to gastric or pancreatic volvulus, and recurrent pancreatitis 4 9 15 16. Triads of abdominal examination findings in WS are a hard ovoid mass, painless movement of this mass towards the left hypochondrium with limitations to movement in other directions and left upper quadrant resonance to percussion 17.…”