Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon

Abstract

Wandering spleen is a rare condition, characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries. Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported. We report a case of wandering spleen associated with mesenteroaxial gastric volvulus, pancreatic volvulus and rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon in a young female.

Splenic torsion with involvement of pancreas and descending colon in a 9-year-old boy

“…Splenic torsion is a rather uncommon condition associated with the absence, underdevelopment or hyperlaxity of splenic suspensory ligaments, which causes an increased mobility of the spleen. 1–3 In addition to that, a long vascular pedicle predisposes to acute or chronic intermittent torsion with or without infarction depending on whether congestion of the organ occurs or not. This condition is also referred to as “wandering spleen” with two peaks of incidence in children aged less than 10 years, as in this reported case, and in females of childbearing age.…”

“…This condition is also referred to as “wandering spleen” with two peaks of incidence in children aged less than 10 years, as in this reported case, and in females of childbearing age. 1, 4,5 This condition also accounts for 0.2–0.3% of all splenectomies. 3, 6,7 The involvement of other organs are rather rare.…”

Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature

“…Wandering spleen is a rare condition characterized by an excessive mobility of the spleen that can “wander” from its anatomical location to any other position in the abdominal cavity, frequently in the lower quadrants due to gravity [ 1 , 11 ]. Despite being most common in reproductive age women as a result of “acquired” ligamentous laxity, wandering spleen is also described in pediatric age with a peak of incidence in male under the first year [ 3 , 7 ]. In this group a “congenital” cause has been proposed, secondary to a failure in the development of splenic ligaments, from the dorsal mesentery, that anchor it to the stomach, diaphragm, colon, and retroperitoneum; as a result, the spleen is sustained only by its vascular pedicle with an increased risk of torsion [ 1 , 4 – 6 ].…”

“…In fact, in an early report, we found 16 of 19 surgically treated cases for gastric volvulus in children had a concurrent wandering spleen [ 24 ]. Analyzing the literature, we found a total of 35 cases reported [ 3 , 7 , 8 , 20 , 21 , 24 , 26 – 34 ].…”

“…Some authors propose a conservative management for chronic gastric volvulus with mild or moderate symptoms [ 19 , 23 , 41 ]. Although successful results were obtained with nonsurgical treatment, in our opinion surgery should be considered in order to avoid complications and recurrences [ 7 , 20 ]. Regarding the technique, a contemporary anterior and fundal gastropexy, as in our case, should be performed, with the aim of fixing the stomach, decreasing the risk of reherniation and/or recurrences and to prevent gastroesophageal reflux by restoring angle of His [ 2 , 6 , 20 ].…”