Wandering spleen: a unique cause of acute abdomen

Abstract

We present the case of a 16-year-old boy presented with 2-week episode of wor-sening lower abdominal pain. Clinically, there was a tender palpable mass on the suprapubic region. Ultrasonography showed an absent spleen at its usual area, instead suprapubic mass suggestive of ectopic spleen was identified. An emer-gency laparotomy revealed a congested spleen in the pelvic cavity. Splenectomy was undertaken as it was non-viable. The patient was discharged uneventfully with triple vaccinations. We describe this unique entity with its literature review. (Folia Morphol 2018; 77, 2: 400-402).

Laparoscopic Splenectomy of a Wandering Pelvic Splenomegaly in a Young Woman Treated in Childhood with Surgery for Diaphragmatic Hernia and Adhesiolysis for Intestinal Obstruction

“…As well known by general surgeons, whether to perform splenopexy or splenectomy depends on the intraoperative findings of a viable spleen. Splenectomy is indicated in splenomegaly, hypersplenism, and torsion of the vascular pedicle with splenic infarction [ 21 , 22 ], while splenopexy should be the treatment of choice for ectopic spleens to avoid the risk of sepsis, especially in the elderly, children, or patients with chronic diseases [ 2 ]. The increasing awareness of the importance of splenic function and the concern about overwhelming post-splenectomy infection are among the factors promoting splenopexy as the treatment of choice for WS [ 12 , 13 ].…”

“…Viana et al [ 7 ] reviewed the literature, reporting that 69.5% of patients with WS needed splenectomy and that 78.6% of surgeries were laparotomic. Nonoperative management of a WS is not advised, as there is a 65% chance of torsion with ischemic splenic infarction [ 1 ], while a conservative treatment such as splenopexy of an asymptomatic WS may be associated with some complications [ 22 ]. On the other hand, since the patient wished to have a pregnancy in the future, the decision to exclude the splenopexy was reinforced by the potential re-dislocation of the WS due to difficulty restoring anatomy, which could have exposed the patient and baby to emergency surgery.…”