Splenic torsion mistaken for an ovarian cyst: a case report.

BACKGROUND: Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed. CASE PRESENTATION: A 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days. CONCLUSION: Splenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.

Torsión esplénica / Splenic Torsion

Introducción: El síndrome de torsión se incluye dentro de los síndromes que causan abdomen agudo quirúrgico. Como causa poco frecuente de este síndrome se encuentra la torsión esplénica en bazos que tienen anomalía en su fijación. Objetivo: Informar sobre la evolución de una paciente tratada por torsión de un bazo errante. Presentación del caso: Paciente de ocho años de edad, femenina, de color no blanco de la piel, con antecedentes de dolor abdominal crónico recurrente, que acudió al Servicio de Urgencias del Hospital Pediátrico de Cienfuegos Paquito González Cueto con dolor abdominal agudo, intermitente, de 48 horas de evolución, vómitos, abdomen doloroso a la palpación profunda en cuadrante superior izquierdo y masa palpable en flanco lateral del mismo lado de tres cm. Se sospechó una torsión esplénica. Se realizó, como complementario diagnóstico ultrasonido abdominal Doppler y tomografía contrastada de abdomen. Se hizo laparotomía y se encontró bazo torcido, con cambios de coloración por la isquemia, que recuperó su color normal después de la destorsión. Se fijó el órgano a la pared abdominal. La evolución posquirúrgica resultó satisfactoria. Conclusiones: La torsión esplénica, aunque infrecuente, debe sospecharse en pacientes con dolor intermitente y masa palpable, principalmente en flanco lateral izquierdo. La tomografía contrastada resulta el examen diagnóstico de elección y se requiere de un diagnóstico temprano para poder conservar el bazo, órgano muy importante para una mejor función inmunológica en los niños(AU)

Introduction: Torsion syndrome is included among the syndromes causing acute surgical abdomen. A rare cause of this syndrome is splenic torsion in spleens with abnormal fixation. Objective: To report on the evolution of a patient treated for torsion of an errant spleen. Case presentation: Eight-year-old female patient, non-white skin color, with a history of recurrent chronic abdominal pain, who attended the Emergency Department of the Paquito González Cueto Pediatric Hospital of Cienfuegos with intermittent acute abdominal pain of 48 hours of evolution, vomiting, painful abdomen on deep palpation in the left upper quadrant and palpable mass in the lateral flank of the same side measuring three centimeters. Splenic torsion was suspected. Doppler abdominal ultrasound and contrasted tomography of the abdomen were performed as a complementary diagnosis. Laparotomy was performed and the spleen was found to be twisted, with changes in color due to ischemia, which recovered its normal color after detorsion. The organ was fixed to the abdominal wall. The postoperative evolution was satisfactory. Conclusions: Splenic torsion, although rare, should be suspected in patients with intermittent pain and palpable mass, mainly in the left lateral flank. Contrast tomography is the diagnostic test of choice and early diagnosis is required to preserve the spleen, a very important organ for better immune function in children(AU)

Wandering spleen, which is torsioned with the distal pancreas.

There are many causes of acute abdominal pain. One of them is wandering splenic torsion. We aimed to discuss a case in which the distal pancreas and spleen were torsion together and underwent splenectomy in the light of the literature. A 19-year-old male patient with sudden onset of abdominal pain underwent splenectomy after physical examination and imaging revealed splenic torsion. Early diagnosis is important as life-threatening complications may develop. Emergency surgery should be performed in patients with splenic ischemia. It should be kept in mind that the pancreas may be torsioned along with the spleen. Surgeons need to be careful during splenectomy to avoid injury to the pancreas.

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

BACKGROUND: Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction. METHODS: From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized. RESULTS: There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4-170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient. CONCLUSIONS: Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen.

[Acute abdomen based on a wandering spleen]. / Acute buik op basis van een wandelende milt.

BACKGROUND: A wandering spleen is a relatively unknown condition, where the spleen may be enlarged and is located in an aberrant position in the abdomen. It is caused by abnormally constructed or absent ligaments that should keep the spleen in the correct position or an excessively long vascular stem. The pathophysiology is congenital or secondary to trauma, abdominal surgery, pregnancy or splenomegaly. CASE DESCRIPTION: A 21-year-old woman was presented at the emergency department with acute abdominal pain in the left lower quadrant. A CT-scan of the abdomen showed splenomegaly, with the spleen showing reduced blood flow and a location in the lower abdomen. During an emergency laparoscopy, the spleen was found to be ischemic based on a torsion of the vascular pedicle. A splenectomy followed and the patient showed an uncomplicated recovery. CONCLUSION: Splenopexy or splenectomy is the treatment of choice for a symptomatic wandering spleen.

Torsion of the wandering spleen as an abdominal emergency: a case report.

BACKGROUND: Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium. CASE PRESENTATION: A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of the wandering spleen's pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully. CONCLUSION: Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.

Acute abdomen due to torsion of the wandering spleen: A rare clinical presentation.

Wandering spleen is defined as the spleen that is not in its normal anatomic position due to the absence or laxity of suspensory ligaments. Congenital and acquired factors play a role in its etiology. It is a rare condition and may cause life-threatening complications as torsion or infarction. Rarely, patients may present to the emergency department with an acute abdomen. They may also present with chronic abdominal pain or intraabdominal mass. Given that its clinical diagnosis is difficult to make, radiological studies have an important role for an accurate diagnosis. In this paper, we presented a 24-year-old patient with torsion of a wandering spleen who presented with an acute abdomen and underwent laparoscopic splenectomy under urgent conditions.

Wandering spleen as a cause of sinistral portal hypertension

Wandering spleen (WS) is a rare entity characterized by laxity of peritoneal ligaments that hold the spleen stationary. It is most commonly diagnosed in children and young women. Clinical presentation ranges from asymptomatic to acute abdomen. A 19-year-old woman came to the emergency department with history of progressive abdominal pain. She also had previous episodes of hematemesis. A computed tomography scan showed an ectopic spleen with a "whirlpool sign." Laparotomy and splenectomy were performed. WS is characterized by a long vascular pedicle and laxity of peritoneal attachments of the spleen. The etiology is usually congenital. Splenopexy is the main treatment; however, splenectomy is indicated when splenic infarction is present. Despite being rare, this condition may be considered in some cases of abdominal pain. An earlier diagnosis would have allowed us to perform a splenopexy, thus reducing morbidity. (AU)

Torsion of Wandering Spleen: A Case Report.

BACKGROUND: Wandering spleen is defined as the localization of the spleen in the lower parts of the abdomen or the pelvic region, rather than the left upper quadrant. The torsion of wandering spleen is a rare clinical condition. CASE REPORT: We evaluate a case diagnosed with torsion of wandering spleen and underwent splenectomy in our hospital and discuss it in light of the literature. A 26-year-old man presented to the emergency department with abdominal pain and abdominal distention. The patient was diagnosed with the torsion of wandering spleen based on computed tomography scan results. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The torsion of wandering spleen is rare in patients presenting with acute abdominal pain, but it is an important condition that should be considered in the differential diagnosis. The diagnosis of wandering spleen should be made before the development of potentially life-threatening complications. Emergency surgery should be undertaken in patients with splenic infarction.

Wandering Spleen in a 1-Year-Old Girl: An Enigmatic Journey to Find the Hiding Necrotic Spleen.

Wandering spleen, otherwise known as ectopic spleen, is a rare congenital or acquired condition, especially in pediatric patients, characterized by elongated splenic pedicle due to congenital or acquired laxity of suspensory splenic ligaments resulting in exaggerated splenic mobility that predisposes it to torsion and often to subsequent infarction. We present a case of a 1-year old Caucasian female who presented with acute abdomen showing infarcted ectopic spleen on imaging. Most patients with infarcted spleen require surgery as the standard intervention. However, our patient was managed medically and had an excellent outcome in the absence of surgery.

Wandering spleen: a rare complication of sleeve gastrectomy.

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.

[Torsion of wandering spleen - unusual cause to acute abdominal pain in pediatric patients]. / Vandrande mjälte ­ ovanlig men viktig differentialdiagnos vid akut buksmärta hos barn.

Wandering spleen is a rare reason for acute abdominal pain in pediatric patients caused by laxity of the splenic ligaments. It can be complicated by torsion of the pedicle, leading to ischemia, a situation that in most cases results in acute abdominal surgery. To prevent ischemia of a mobile spleen caused by a total occlusion of the pedicle, splenopexy can be considered. We present an unusual case where changes in the position of the operating table during diagnostic laparoscopy might have caused a total occlusion of the pedicle.

Emergencies in the Treatment of Wandering Spleen.

BACKGROUND: Wandering spleen is a rare entity that may pose a surgical emergency following torsion of the splenic vessels, mainly because of a delayed diagnosis. Complications after surgery for wandering spleen may necessitate emergency treatment. OBJECTIVES: To describe the clinical course and treatment for children who underwent emergency surgeries for wandering spleen at a tertiary pediatric medical center over a 21 year period and to indicate the pitfalls in diagnosis and treatment as reflected by our experience and in the literature. METHODS: The database of a tertiary pediatric medical center was searched retrospectively for all children who underwent emergency treatment for wandering spleen between 1996 and 2017. Data were collected from the medical files. The relevant literature was reviewed. RESULTS: Of ten patients who underwent surgery for wandering spleen during the study period, five underwent seven emergency surgeries. One patient underwent surgery immediately at initial presentation. In the other four, surgical treatment was delayed either due to misdiagnosis or for repeated imaging studies to confirm the diagnosis. Emergency laparotomy revealed an ischemic spleen in all patients; splenectomy was performed in two and the spleen was preserved in three. Four of the seven emergency operations were performed as the primary surgery and three were performed to treat complications. CONCLUSIONS: Wandering spleen should ideally be treated on an elective or semi-elective basis. Surgical delays could be partially minimized by a high index of suspicion at diagnosis and by eliminating unnecessary and time-consuming repeated imaging studies.

[Wandering spleen in a patient hospitalized with acute abdomen].

An 11-year-old girl was hospitalized with a two-day history of lower abdominal pain. The patient had a localized peritoneal reaction in the right lower quadrant, an elevated C-reactive protein level, and an increased white blood cell count. On the suspicion of acute appendicitis a diagnostic laparoscopy was performed. This revealed a misplaced spleen in the right side of the pelvis with a partly torsion of a long vascular pedicle. The splenic tissue was vital without any sign of ischaemia. However, splenopexy was not possible, and an uncomplicated elective splenectomy was performed.

[Wandering spleen: an unusual cause of acute abdomen]. / Bazo errante: una causa infrecuente de abdomen agudo.

Wandering spleen syndrome is a rare condition in which absence or laxity of splenic fixing elements predisposes to an unusual location in the abdomen and an increasing risk of twisting and infarction. Its etiology may be congenital or acquired and clinical presentation is variable. Diagnosis is based on clinical suspicion, laboratory and imaging. Surgery is the only definitive treatment for this pathology. We report the case of a 23 year old woman with a history of recurrent episodes of abdominal pain in the left upper quadrant since childhood. On physical examination she was afebrile, hemodynamically stable, with marked abdominal tenderness in the left upper quadrant. Ultrasonography showed homogeneous splenomegaly. Abdominal CT-scan presented an enlarged, eutopic spleen, with swirling and congestion of hilum vessels. Splenic ischemia due to organ torsion was suspected. Exploratory laparoscopy was performed showing an 18 cm in diameter spleen free in left upper quadrant, with varicose veins in the periphery and without fixing ligaments. Laparoscopic splenectomy was completed. The pathology report showed ischemic necrosis of the organ. The patient progressed favorably and was discharged on the third postoperative day.

Bazo errante: una causa infrecuente de abdomen agudo / Wandering spleen: an unusual cause of acute abdomen

El síndrome de bazo errante es una condición infrecuente en la cual existe ausencia o hiperlaxitud en los elementos de fijación esplénicos que predispone a una ubicación inusual en el abdomen y mayor riesgo de torsión e infarto visceral. Su etiología puede ser congénita o adquirida y la presentación clínica es variable. El diagnóstico se basa en sospecha clínica, laboratorio y estudios por imágenes. La cirugía es el único tratamiento definitivo para esta afección. Presentamos el caso de una mujer de 23 años de edad con antecedentes de episodios recurrentes de dolor en hipocondrio izquierdo desde la infancia. Al examen físico se encontraba hemodinámicamente estable, afebril y con dolor en hipocondrio izquierdo. La ecografía mostró esplenomegalia homogénea y la tomografía de abdomen evidenció un bazo aumentado de tamaño, de posición conservada, con arremolinamiento y congestión de los vasos en el hilio esplénico. Se interpretó el cuadro como isquemia esplénica secundaria a torsión del pedículo vascular. Se realizó laparoscopia exploradora que evidenció bazo de 18 cm libre en hipocondrio izquierdo, con venas varicosas en la periferia y sin ligamentos de fijación. Se realizó esplenectomía por vía laparoscópica. La anatomía patológica informó necrosis isquémica del órgano. Evolucionó favorablemente con alta hospitalaria al tercer día postoperatorio.

Wandering spleen syndrome is a rare condition in which absence or laxity of splenic fixing elements predisposes to an unusual location in the abdomen and an increasing risk of twisting and infarction. Its etiology may be congenital or acquired and clinical presentation is variable. Diagnosis is based on clinical suspicion, laboratory and imaging. Surgery is the only definitive treatment for this pathology. We report the case of a 23 year old woman with a history of recurrent episodes of abdominal pain in the left upper quadrant since childhood. On physical examination she was afebrile, hemodynamically stable, with marked abdominal tenderness in the left upper quadrant. Ultrasonography showed homogeneous splenomegaly. Abdominal CT-scan presented an enlarged, eutopic spleen, with swirling and congestion of hilum vessels. Splenic ischemia due to organ torsion was suspected. Exploratory laparoscopy was performed showing an 18 cm in diameter spleen free in left upper quadrant, with varicose veins in the periphery and without fixing ligaments. Laparoscopic splenectomy was completed. The pathology report showed ischemic necrosis of the organ. The patient progressed favorably and was discharged on the third postoperative day.

Radiofrequency-Assisted Partial Splenectomy Plus Splenopexy--A Modified Surgical Procedure for Wandering Spleen: A Case Report.

Wandering spleen is an extremely rare clinical condition characterized by abnormal anatomical position of the spleen. Up to now, its etiology remains unknown, and the best surgical procedure is still an area to explore in the future. In this article, we present the case of a 24-year-old woman with wandering spleen combined with congenital heart disease and pigeon chest. Based on the clinical features and our experiences of radiofrequency ablation for preservation of the spleen in traumatic spleen rupture, we successfully performed a modified splenectomy and splenopexy method. Since the operation, the organ has remained in place with good perfusion and function.