Wandering splenomegaly reduction after splenopexy

Abstract

Introduction and importance A wandering spleen is characterized by excessive splenic mobility due to the laxity of its ligaments, which leads to spleen migration and its long mobile vascular pedicle is liable to torsion. The purpose of this paper was to present a wandering splenomegaly reduction after splenic detorsion and splenopexy. Case presentation A 14-year-old boy presented a symptomatic visible pelvic wandering splenomegaly with torsion of the splenic pedicle. He was submitted to laparotomy, detorsion of the spleen, and splenopexy to the left diaphragm and surrounded peritoneum. The patient had an uneventful follow-up and was discharged from the hospital on the second postoperative day. All laboratory exams went to normal. The size of the spleen reduced from the 22 × 16 × 13 cm before the treatment to 14 × 12 × 10 cm after the surgical procedure. Clinical discussion The most relevant aspect of this communication is the reduction of the huge splenomegaly to a normal size spleen after detorsion of the splenic vessels and splenopexy to the left diaphragm. Reduction of the splenic size is well-known after distal splenorenal shunt, but this is the first publication of a spontaneous splenic size reduction after treating a congestive wandering splenomegaly by detorsion of the spleen pedicle. Conclusion Ectopic congestive splenomegaly due to the splenic pedicle rotation is adequately treated by splenic detorsion and splenopexy in its proper subdiaphragmatic site, which reduces the splenic size to normal.

Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction

“…Goyal et al performed a salvage splenopexy for a patchy reperfused spleen after detorsion, which was proved viable after 4 months by biopsy [39]. Petroianu et al reported a huge wandering spleen returning to normal size showed by CT 4 years after splenopexy [40]. Katsura et al and Takayasu et al resected large but viable wandering spleens with torsion and implanted splenic tissue to omentum, which were proved viable and functional by scintigram and absence of Howell-Jolley bodies in blood specimens [34,35].…”

Dwarfism associated with wandering splenomegaly

“…The ectopic spleen is a rare condition, which is usually asymptomatic, but it may be responsible for chronic abdominal pain with gastrointestinal and urinary symptoms [ 9–15 ]. Patients with torsion of the wandering spleen may not only have acute abdomen or chronic and intermittent symptoms, but also splenomegaly and splenic infarction as a result of vascular congestion [ 7 , 8 , 10 , 14 ].…”

The left gastro-omental vessels are able to maintain the entire spleen blood supply

“…An ectopic spleen is a rare condition, but more than 1000 papers have been published describing this disorder, which is most commonly found in women of reproductive age. 1 , 5 - 8 Diagnosis is difficult because of nonspecific clinical or laboratory findings and is only confirmed by imaging exams. 7 , 8 The condition is usually asymptomatic, but may be responsible for chronic abdominal pain associated with gastrointestinal and urinary symptoms.…”

“… 1 , 5 - 8 Diagnosis is difficult because of nonspecific clinical or laboratory findings and is only confirmed by imaging exams. 7 , 8 The condition is usually asymptomatic, but may be responsible for chronic abdominal pain associated with gastrointestinal and urinary symptoms. In fact, the purpose of this case report was not to present one more wandering spleen, but to emphasize the particular vascularization of this spleen, by the left gastro-omental vessels only.…”

“…This mobile spleen is supplied by a long vascular pedicle and may be associated with other congenital disorders. 5 - 8 …”