Abstract
Torsion of wandering spleen is a rare clinical condition in which the spleen is devoid of its normal peritoneal attachment associated with a long vascular pedicle. Women between 20-40 years of age are more likely to be affected. The most common clinical picture is an abdominal mass with pain. For preoperative diagnosis, a high index of suspicion is helpful. Ultrasonography and computerized tomography can also confirm the diagnosis. The treatment is surgical and splenopexy should be the first choice. If ischemia is persistent after detorsion, either laparoscopic or open splenectomy is the choice of procedure. A 26 year old male patient with torsion of an ectopic spleen presenting as a case of acute abdomen is presented in this report. An urgent laparotomy and splenectomy was performed and the patient was discharged at the postoperative third day.
We can say that the torsioned wandering spleen should be kept in mind in every patient who undergoes an urgent operation for acute abdomen, although it is an unusual clinical condition.
Keywords:
Wandering spleen, acute abdomen, torsion of wandering spleen
References
1Sheflin JR, Lee CM, Kretchmar KA. Torsion of wandering spleen and distal pancreas. AJR 1984;142:100-101.
2Soleimani M, Mehrabi A, Kashfi A, Fonouni H, Büchler MW, Kraus TW. Surgical treatment of patients with wandering spleen: Report of six cases with a review of the literature. Surg Today 2007;37:261-269.
3Varga I, Galfiova P, Adamkov M, Danisovic L, Polak S, Kubikova E, Galbavy S. Congenital anomalies of the spleen from an embryological point of view. Med Sci Monit. 2009;15:269-276.
4Lebron R, Self M, Mangram A, Dunn E: Wandering spleen presenting as recurrent pancreatitis. J Soc Laparoendosc Surg 2008; 12: 310–313.
5Buehner M, Baker MS. The wandering spleen. Collective review. Surg Gyne Obst 1992: 175: 373-387.
6Desai DC, Hebra A, Davidoff AM, Schnaufer L. Wandering spleen: A challenging diagnosis. Southern J Med 1997; 90: 439-443.
7Eraklis AR, Filler RM: Splenectomy in childhood. A review of 1413 cases. J Pediat Surg 1972; 7: 383–388. [DOI:10.1016/0022-3468(72)90006-1]
8Tucker ON, Smith J, Fenlon HM, McEntee GP. Recurrent torsion of a wandering spleen. Am J Surg 2004;188:96-97.
9Pearson JB. Torsion of the spleen associated with congenital absence of the left kidney. Br J Surg 1964; 51: 393-395. [DOI:10.1002/bjs.1800510530]
10Satydas T, Nasir N, Bradpiece HA. Wandering spleen: case report and literature review. J R Coll of Surg Edin 2002: 47: 512-514.
11Ben Ely A, Zissin R, Copel L, Vasserman M, Hertz M, Gottlieb P, Gayer G. The wandering spleen: CT findings and possible pitfalls in diagnosis. Clin Radiol. 2006;61:954-958.
12Allen KB, Andrews G, Pediatric wandering spleen-the cause of splenopexy: review of 35 reported cases. J Ped Surg 1989; 24: 432-435. [DOI:10.1016/S0022- 3468(89)80395-1]
13Schmidt SP, Andrews HG, White JJ. The splenic snood: An improved approach for the management of the wandering spleen. J Ped Surg 1992; 27: 1043-1044. [DOI:10.1016/0022-3468(92)90555-L]
14Shaw JHF. Print CG. Postsplenectomy sepsis. Br J Surg 1989; 76: 1074-1080. [DOI:10.1002/bjs.1800761029]
15Qazi SA, Mirza SM, Muhammad AM, Al Arrawi MH, Al-Suhaibani YA. Wandering spleen. Saudi J Gastroenterol 2004;10:1-7.
16Barbaros U, Tükenmez M, Erbil Y, Dinççağ A, Tiryaki B, Özarmağan S, Mercan S, Budak D. Laparoscopic treatment of wandering spleen causing partial colonic obstruction. Surg Laparosc Endosc Percutan Tech 2007;17:462-464.