RESUMO
Gastric volvulus is an uncommon cause of upper gastrointestinal obstruction that occurs when the stomach twists along its vertical (organoaxial) or horizontal (mesenteroaxial) axis. Its rarity combined with its non-specific presentation makes gastric volvulus a diagnostic challenge, especially when the volvulus occurs without underlying structural abnormality such as hiatal hernia. The organoaxial type comprises most cases of this rare diagnosis. Few cases of mesenteroaxial volvulus have been reported in children and even fewer in adults. Here, we present a rare case of acute, idiopathic mesenteroaxial volvulus in a patient in his 70s, that was successfully managed laparoscopically.
Assuntos
Laparoscopia , Volvo Gástrico , Humanos , Volvo Gástrico/cirurgia , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico , Laparoscopia/métodos , Masculino , Idoso , Tomografia Computadorizada por Raios X , Doença AgudaRESUMO
INTRODUCTION: Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION: Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments. CONCLUSION: An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.
Assuntos
Volvo Intestinal , Humanos , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico , Criança , Serviço Hospitalar de Emergência , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico , Incidência , LactenteRESUMO
H-type tracheo-oesophageal fistula is an uncommon type of tracheo-oesophageal malformation. Acute gastric volvulus is another infrequent pathology in children. They rarely present together.We report the case of a toddler with acute gastric volvulus possibly secondary to an undiagnosed H-type tracheo-oesophageal fistula. The fistula was suspected due to persistent gastric distention observed during volvulus detorsion. This kind of tracheo-oesophageal fistula often presents with subtle symptoms making early diagnosis difficult.Acute gastric volvulus is a life-threatening condition. Gastric distension caused by the passage of air into the stomach through the fistula could be a triggering factor for gastric volvulus.
Assuntos
Volvo Gástrico , Fístula Traqueoesofágica , Humanos , Volvo Gástrico/complicações , Volvo Gástrico/cirurgia , Volvo Gástrico/diagnóstico , Volvo Gástrico/diagnóstico por imagem , Fístula Traqueoesofágica/diagnóstico , Fístula Traqueoesofágica/cirurgia , Fístula Traqueoesofágica/complicações , Doença Aguda , Masculino , LactenteRESUMO
BACKGROUND: Acute complete gastric volvulus is a rare and life-threatening disease, which is prone to gastric wall ischemia, perforation, and necrosis. If it is not treated by surgery in time, the mortality rate can range from 30 to 50%. Clinical presentations of acute gastric volvulus are atypical and often mimic other abdominal conditions such as gastritis, gastroesophageal reflux, gastric dilation, and pancreatitis. Imaging studies are crucial for diagnosis, with barium meal fluoroscopy being the primary modality for diagnosing gastric volvulus. Cases of acute gastric volvulus diagnosed by ultrasound are rarely reported. CASE PRESENTATION: We reported a rare case of acute gastric volvulus in a 4-year-old Chinese girl who presented with vomiting and abdominal pain. Ultrasound examination revealed the "whirlpool sign" in the cardia region, raising suspicion of gastric volvulus. Diagnosis was confirmed by X-ray barium meal fluoroscopy, which indicated left-sided diaphragmatic hernia and obstruction at the cardia region. Surgical intervention confirmed our suspicion of acute complete gastric volvulus combined with diaphragmatic hernia. CONCLUSION: In this case, we reported an instance of acute complete gastric volvulus. Ultrasound revealed a "whirlpool sign" in the cardia, which is likely to be a key sign for the diagnosis of complete gastric volvulus.
Assuntos
Hérnias Diafragmáticas Congênitas , Volvo Gástrico , Humanos , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Volvo Gástrico/diagnóstico , Feminino , Pré-Escolar , Doença Aguda , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Ultrassonografia , FluoroscopiaRESUMO
A toddler presented with complaints of multiple episodes of vomiting lasting 1 week. He had a history of similar episodes of vomiting several times as an infant. Clinically, he was underweight and had tachypnoea and tachycardia. Laboratory investigations revealed hyponatraemic metabolic acidosis. His chest radiograph revealed an intrathoracic herniation of the stomach with an atypical presence towards the right hemithorax, suggestive of a torsion. A contrast-enhanced CT of the chest and abdomen confirmed an intrathoracic gastric herniation, with an organo-axial gastric volvulus, with no features of strangulation. He underwent an emergency laparotomy and intraoperatively the stomach was found to have reduced to its intra-abdominal position, and the hernia and volvulus had also self-reduced. In view of the multiple symptomatic episodes, an anterior gastropexy was performed to prevent recurrences. The patient recuperated well and has not had any recurrences in the follow-up period. This report adds to the minimalistic literature.
Assuntos
Hérnia Hiatal , Volvo Gástrico , Masculino , Lactente , Humanos , Pré-Escolar , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico por imagem , Hérnia Hiatal/cirurgia , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Vômito/etiologia , Vômito/cirurgia , LaparotomiaRESUMO
Large hiatal hernias, besides being more prevalent in the elderly, have a different clinical presentation: less reflux, more mechanical symptoms, and a greater possibility of acute, life-threatening complications such as gastric volvulus, ischemia, and visceral mediastinal perforation. Thus, surgical indications are distinct from gastroesophageal reflux disease-related sliding hiatal hernias. Heartburn tends to be less intense, while symptoms of chest pain, cough, discomfort, and tiredness are reported more frequently. Complaints of vomiting and dysphagia may suggest the presence of associated gastric volvulus. Signs of iron deficiency and anemia are found. Surgical indication is still controversial and was previously based on high mortality reported in emergency surgeries for gastric volvulus. Postoperative mortality is especially related to three factors: body mass index above 35, age over 70 years, and the presence of comorbidities. Minimally invasive elective surgery should be offered to symptomatic individuals with good or reasonable performance status, regardless of age group. In asymptomatic and oligosymptomatic patients, besides obviously identifying the patient's desire, a case-by-case analysis of surgical risk factors such as age, obesity, and comorbidities should be taken into consideration. Attention should also be paid to situations with greater technical difficulty and risks of acute migration due to increased abdominal pressure (abdominoplasty, manual labor, spastic diseases). Technical alternatives such as partial fundoplication and anterior gastropexy can be considered. We emphasize the importance of performing surgical procedures in cases of large hiatal hernias in high-volume centers, with experienced surgeons.
Assuntos
Parede Abdominal , Refluxo Gastroesofágico , Hérnia Hiatal , Laparoscopia , Volvo Gástrico , Humanos , Idoso , Hérnia Hiatal/cirurgia , Volvo Gástrico/complicações , Volvo Gástrico/cirurgia , Brasil , Laparoscopia/métodos , Refluxo Gastroesofágico/cirurgia , Fundoplicatura/efeitos adversosRESUMO
BACKGROUND AND AIMS: Acute esophageal necrosis (AEN) in the setting of gastric volvulus is a rare condition with only a handful of cases reported. Volvulus may contribute to AEN by limiting tissue perfusion and promoting massive reflux of gastric contents on compromised esophageal mucosa. METHODS: We reviewed 225 original articles, literature reviews, case series, brief reports, case reports, and discuss six total cases of co-occurring esophageal necrosis and gastric volvulus. RESULTS AND CONCLUSIONS: We present the first comprehensive analysis of all reported cases in the literature to date and formulate management strategies for the co-occurrence of AEN and volvulus. Management of AEN should be directed at correcting underlying medical conditions, providing hemodynamic support, initiating nil-per-os restriction, and administering high-dose proton pump inhibitor therapy. Surgical intervention is typically reserved for cases of esophageal perforation with mediastinitis and abscess formation.
Assuntos
Anormalidades do Sistema Digestório , Perfuração Esofágica , Volvo Intestinal , Volvo Gástrico , Humanos , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico , NecroseRESUMO
Congenital diaphragmatic hernias are rarely seen and they are usually diagnosed in the neonatal period. Congenital diaphragmatic de-fect, also known as Bochdalek hernia, usually occurs with the persistence of the pleuroperitoneal canal in the left posterolateral region of the diaphragm in the embryological period. Although it is rarely seen in the adults, conditions such as intestinal volvulus, strangulation, or perforation with congenital diaphragm defect progress with high mortality and morbidity. In this study, we reported our case that we operated for intrathoracic gastric perforation with congenital diaphragmatic defect. When the patient admitted to the hospital, he had an atypical abdominal pain, significant back pain, and suspicious respiratory complaints. Radiological imaging showed that the stomach and the spleen were located in the left hemithorax due to diaphragmatic hernia also stomach was very dilated. Tachycardia, hypotension, and low saturation developed on the 2nd day of the patient's hospitalization. In the control imaging of the patient, in the left hemithorax, stomach was collapsed and the surrounding appearance compatible with hydropneumothorax, after that findings emergency laparotomy was decided. During the operation, as demonstrated by the radiological findings, a diaphragm defect was seen in the left posterolateral region of the diaphragm. The stomach and spleen were herniated to the left hemithorax from this defect. The stomach and spleen were reduced into the abdomen. The left hemithorax was lavaged with 2000 cc isotonic, left tube thoracostomy was applied, and the diaphragm was repaired. The anterior stomach was primarily repaired. In post-operative follow-up, there were no complications other than wound infection and thoracic tube of the patient was removed. The patient who tolerated enteral food was discharged from hospital with full recovery.
Assuntos
Hérnias Diafragmáticas Congênitas , Gastropatias , Volvo Gástrico , Masculino , Recém-Nascido , Humanos , Adulto , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Diafragma , Gastropatias/complicações , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgiaRESUMO
Nowadays laparoscopic Nissen fundoplication represents the gold standard in surgical treatment of complicated Gastro-Esophageal-Reflux Disease (GERD), above all in cerebral palsy patients. In non-neurological patients without gastrostomy Nissen fundoplication can create some problems (gas bloat syndrome, dysphagia). Laparoscopic Hill-Snow repair is an established surgical alternative, but it is reported only in adult population. We describe our modification of Hill-Snow technique and our experience in a large series of non-neurological children in order to report its effectiveness and applicability in pediatric patients affected by complicated GERD. Between 2000 and 2022, 319 children underwent surgical correction of gastro-esophageal reflux at our Department. All were affected by complicated gastro-esophageal reflux unresponsive to PPI (Proton Pump Inhibitors). 251 underwent laparoscopic Nissen fundoplication; 68 non-neurological patients underwent laparoscopic Hill-Snow repair. Of these 68 children 48 were males (71%) and 20 females (29%); median age was 5years (3 months-11 years). Weight range was 4-37kg. 52 patients (76.5%) presented the following symptoms: retrosternal pain, dysphagia, regurgitation, coughing, failure to thrive, persisting reflux esophagitis. 16 (23.5%) had chronic respiratory problems (aspiration, apneic-spells, dysphagia, coughing, choking, gagging). For 8 (11.8%) symptoms were expression of chronic recurrent gastric volvulus. All underwent modified-laparoscopic-Hill-Snow repair. Contrast study showed sliding hiatal hernia in 55 patients (81%), while endoscopy demonstrated 16 cases of histologically severe esophagitis (23.5%) and 52 of mild esophagitis (76.5%). No intraoperative/postoperative complications were recorded. 60patients had a complete follow-up (range 1-20 years). 60/68 patients were evaluated with barium-swallow-study at 6-12 months; 40/68 patients with upper-gastrointestinal-endoscopy at 12months. No relapse was reported. 50 patients (73.7%) were symptom-free. 18 (26.3%) referred occasional epigastric pain, associated with vomit in 2 cases. 64 (94.1%) referred ability to vomit; 4 temporary difficulty to swallow (average 30 days). All patients reported being able to burp. 3(4.5%) presented episodes of gas-air-bloat during the first 2 months with spontaneous resolution. No case of dumping syndrome was recorded. This technique's modification yields excellent results in term of relapse and side effects at long-term follow-up. We reported the first and largest pediatric series in non-neurological children with encouraging results.
Assuntos
Transtornos de Deglutição , Esofagite Péptica , Refluxo Gastroesofágico , Laparoscopia , Volvo Gástrico , Adulto , Masculino , Feminino , Humanos , Criança , Pré-Escolar , Fundoplicatura/efeitos adversos , Fundoplicatura/métodos , Seguimentos , Neve , Resultado do Tratamento , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Esofagite Péptica/complicações , Esofagite Péptica/cirurgia , Volvo Gástrico/complicações , Volvo Gástrico/cirurgia , Dor/complicações , Dor/cirurgiaAssuntos
Fístula Biliar , Fístula Brônquica , Volvo Gástrico , Humanos , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Fístula Biliar/complicações , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/cirurgia , Fístula Brônquica/complicações , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/cirurgiaRESUMO
BACKGROUND: During neoadjuvant chemotherapy for giant gastrointestinal stromal tumors, changes in gastrointestinal stromal tumor size are rarely associated with events such as perforation and bleeding that require emergency surgery. Moreover, it is very rare for gastrointestinal stromal tumors to shrink and become mobile, resulting in gastric volvulus. Herein, we report a case of gastrointestinal stromal tumor shrinkage during neoadjuvant imatinib treatment, resulting in gastric volvulus that required surgery. To the best of our knowledge, this is the first reported occurrence of gastric volvulus during neoadjuvant imatinib treatment for a giant gastrointestinal stromal tumor. CASE PRESENTATION: A 58-year-old Japanese woman who was diagnosed with a giant gastric gastrointestinal stromal tumor and administered neoadjuvant imatinib presented to our hospital with complaints of abdominal pain and retching. Enhanced computed tomography revealed that the gastrointestinal stromal tumor had shrunk and shifted in position, and the stomach had organoaxially twisted. Accordingly, the patient was diagnosed with gastric volvulus caused by a gastric gastrointestinal stromal tumor. Conservative treatment did not improve the volvulus; hence, laparotomy was performed. The tumor developed from the lesser curvature of the stomach and caused rotation of the gastric body. The local gastric wall was resected. Histopathological examination confirmed the diagnosis of gastrointestinal stromal tumor. The patient received adjuvant imatinib for 3 years and has been alive for 5 years without recurrence. CONCLUSIONS: Gastric volvulus can be caused by the laxity of the ligaments that hold the stomach and gastric ptosis or esophageal hernia and diaphragmatic hernia; therefore, gastric gastrointestinal stromal tumors rarely cause gastric volvulus. However, a risk of torsion exists if the gastrointestinal stromal tumor develops extramural to lesser curvature and attains a certain size.
Assuntos
Antineoplásicos , Tumores do Estroma Gastrointestinal , Neoplasias Gástricas , Volvo Gástrico , Feminino , Humanos , Pessoa de Meia-Idade , Mesilato de Imatinib/uso terapêutico , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Terapia Neoadjuvante , Antineoplásicos/uso terapêutico , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Neoplasias Gástricas/patologiaRESUMO
We described a case of a man in his 90s with gastric volvulus of which point-of-care ultrasound (POCUS) contributed to a rapid diagnosis. The patient had Borchardt's triad and POCUS showed a distended and fluid-filled stomach, which allowed us to strongly suspect gastric volvulus even prior to the abdominal CT scan. Gastric volvulus is a rare but life-threatening condition that may lead to tissue ischaemia and perforation. Therefore, a prompt diagnosis is extremely important. This case suggests that POCUS can be a powerful tool when clinicians suspect gastric volvulus.
Assuntos
Volvo Gástrico , Serviço Hospitalar de Emergência , Humanos , Masculino , Sistemas Automatizados de Assistência Junto ao Leito , Testes Imediatos , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Tomografia Computadorizada por Raios X/métodos , UltrassonografiaRESUMO
Purpose: To depict the characteristics of a special type of gastric volvulus caused by acute re-herniation of a previous hiatal hernia.Materials and methods: We present the case of a male patient with known history of a giant hiatal hernia who presented to our emergency department with a chief complaint of epigastric pain, oral intolerance and incoercible vomiting in the last 24 h. On suspicion of abdominal complication, an emergent computed tomography (CT) scan was performed.Results: Gastric volvulus secondary to downward re-herniation of the fundus into the abdominal cavity was the cause of this patient's symptoms. This mechanism, which was demonstrated by comparing the CT findings of the acute episode with previous imaging studies, reveals a largely unrecognized pathogenic mechanism of gastric volvulus.Conclusions: Acute gastric volvulus should be suspected in patients with hiatal hernia. CT allows its diagnosis and likely underlying pathophysiological mechanism.
Assuntos
Cavidade Abdominal , Hérnia Hiatal , Volvo Gástrico , Humanos , Masculino , Volvo Gástrico/complicações , Volvo Gástrico/diagnóstico , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Tomografia Computadorizada por Raios X , Dor AbdominalRESUMO
A 6-year-old neutered male golden retriever mix dog was presented for investigation of acute restlessness, increased respiratory effort, non-productive retching, and anorexia. Initial abdominal radiography revealed marked gastric dilation with a normal gastric shape and position, along with mineralized granular material in the pyloric region, consistent with a pyloric outflow obstruction secondary to suspected sand impaction. The dog was stabilized with gastric trocharization and medical management with intravenous fluids, antiemetics, polyethylene glycol via a nasogastric tube, and analgesia was initiated. The dog developed aspiration pneumonia during hospitalization and became oxygen-dependent. There was no significant improvement of clinical status despite 72 h of medical management, and surgical intervention was subsequently recommended. Exploratory laparotomy revealed a counterclockwise gastric dilatation and volvulus. The stomach was repositioned into normal anatomic position and an incisional gastropexy was performed. The dog was maintained in the intensive care unit for 4 d postoperatively. Currently, 3 mo postoperatively, the dog is healthy without recurrence of clinical signs. Key clinical message: Counterclockwise gastric dilatation and volvulus is a rare condition in veterinary medicine; however, it should be considered in a patient with acute gastric distension and signs of pyloric outflow obstruction when characteristic radiological signs of clockwise gastric dilatation and volvulus are absent, and there is radiological evidence of persistent gastric foreign material despite medical management. Misdiagnosis of counterclockwise gastric dilatation and volvulus can delay definitive surgical intervention and lead to higher morbidity and mortality.
Dilatation gastrique dans le sens inverse des aiguilles d'une montre et volvulus chez un chien. Un chien golden retriever mâle castré âgé de 6 ans a été présenté pour évaluation à la suite d'agitation aiguë, d'un effort respiratoire accru, des haut-le-coeur non productifs et d'anorexie. La radiographie abdominale initiale a révélé une dilatation gastrique marquée avec une forme et une position gastrique normales, ainsi qu'un matériau granulaire minéralisé dans la région pylorique, compatible avec une suspicion d'obstruction de l'écoulement pylorique secondaire à une impaction par du sable. Le chien a été stabilisé avec une trocarisation gastrique et une prise en charge médicale avec des fluides intraveineux, des antiémétiques, du polyéthylène glycol via une sonde nasogastrique, et une analgésie a été initiée. Le chien a développé une pneumonie par aspiration pendant l'hospitalisation et est devenu dépendant de l'oxygène. Il n'y a pas eu d'amélioration significative de l'état clinique malgré 72 h de prise en charge médicale et une intervention chirurgicale a été recommandée. La laparotomie exploratrice a révélé une dilatation gastrique dans le sens inverse des aiguilles d'une montre et un volvulus. L'estomac a été repositionné en position anatomique normale et une gastropexie incisionnelle a été réalisée. Le chien a été maintenu en unité de soins intensifs pendant 4 jours après l'opération. Actuellement, 3 mois après l'opération, le chien est en bonne santé sans récidive des signes cliniques.Message clinique clé :La dilatation dans le sens inverse des aiguilles d'une montre et le volvulus gastriques sont une affection rare en médecine vétérinaire; cependant, cela doit être envisagé chez un patient présentant une distension gastrique aiguë et des signes d'obstruction de l'écoulement pylorique en l'absence de signes radiologiques caractéristiques de dilatation gastrique dans le sens des aiguilles d'une montre et de volvulus, et en cas de preuve radiologique de corps étranger gastrique persistant malgré la prise en charge médicale. Un diagnostic erroné de dilatation gastrique dans le sens inverse des aiguilles d'une montre et de volvulus peut retarder l'intervention chirurgicale définitive et entraîner une morbidité et une mortalité plus élevées.(Traduit par Dr Serge Messier).
Assuntos
Doenças do Cão , Dilatação Gástrica , Gastropexia , Volvo Intestinal , Volvo Gástrico , Animais , Doenças do Cão/diagnóstico por imagem , Doenças do Cão/cirurgia , Cães , Dilatação Gástrica/complicações , Dilatação Gástrica/cirurgia , Dilatação Gástrica/veterinária , Gastropexia/veterinária , Volvo Intestinal/complicações , Volvo Intestinal/veterinária , Masculino , Volvo Gástrico/complicações , Volvo Gástrico/cirurgia , Volvo Gástrico/veterináriaRESUMO
PURPOSE: Though gastric volvulus in neonates and infants resolves by conservative therapy and aging, some cases require surgical intervention. This study aimed to review the cases of gastric volvulus requiring surgical intervention and evaluate their characteristics. METHODS: We retrospectively reviewed gastric volvulus cases requiring surgical intervention. Surgical indication was persistent acute gastric volvulus and repeated hospitalization for gastric volvulus. We evaluated the characteristics of those cases requiring surgical intervention and the surgical results of laparoscopic gastropexy. RESULTS: The median age of patients included was 4 years (range: 1-6 years). All eight cases of gastric volvulus requiring sugery had congenital spleen diseases. Six of the eight cases suffered from a wandering spleen, while two cases presented with situs inversus with asplenia. Both splenopexy (preperitoneal distension balloon [PDB] or blunt separaion methods) and gastropexy were performed in cases with wandering spleen. No postoperative complications were reported in any of the eight cases, except the recurrence of gastric volvulus due to suture shedding in one case. CONCLUSION: Laparoscopic gastropexy for gastric volvulus and splenopexy for cases concomitant with wandering spleen were found to be effective surgical approaches. Both PDB and blunt separation methods for making extraperitoneal pockets for the spleen were employed successfully.