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.

[Situs inversus associated with wandering spleen and common mesentery detected from medical imaging in Niamey (Niger): a case report]. / Situs ambigus avec rate baladeuse et mésentère commun découvert grâce à l'imagerie médicale à Niamey (Niger): à propos d'un cas.

Situs inversus is a rare anomaly characterized by mirror-image location of of thoracic and abdominal organs. It can be associated with several other malformations including common mesentery which is a rare type of malrotation that develops as a result of the rotation of the intestines and with wandering spleen which is a rare anomaly characterized by the unusual position of the spleen in the abdomen and that most often occurs in children. We here report the case of a male patient aged 8 years diagnosed with these three entities. He was admitted with chronic abdominal pain. Ultrasound assessment was performed. Clinical examination showed sensitive pelvic mass. Ultrasound objectified abnormal position of the liver and spleen (the liver in the left hypochondrium and the spleen in the right hypochondrium) and an oval isoechogenic mass characterized by tissue structures within the echo image in the spleen, located in the supravesical fossa, lateralized to the right. CT scan confirmed that the liver occupied both hypochondria, with the hilus and gallbladder found on the midline; the splenic fossa was empty and the supra-vesical pelvic mass was homogeneous, isodense to splenic parenchyma and raised in the same way to the spleen (it was a floating spleen), its arterial vascular pedicle was directly connected to the abdominal aorta. Intestinal rotation abnormality suggesting common mesentery was also objectified.

[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.

An infarcted wandering spleen leading to a sigmoid volvulus presenting with acute large bowel obstruction: a case report.

A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomical position due to the hyperlaxity of its ligaments. We present a case of wandering spleen complicated by splenic vascular pedicle torsion, thrombosis and subsequent splenic infarction. Compression of the infarcted spleen on the rectosigmoid junction led to the development of a sigmoid volvulus, which presented as an acute large bowel obstruction. The patient underwent emergency laparotomy, splenectomy, sigmoid decompression and sigmoidopexy. After a follow-up period of two years, the volvulus had not recurred.

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.

[A case report of wandering spleen]. / Le syndrome de la rate baladeuse : cas clinique.

INTRODUCTION: Wandering spleen is a rare condition that occurs when there is an acquired or congenital hypelaxity of the suspensory ligaments of the spleen, resulting in its migration to any abdominal or pelvic position. CASE REPORT: A 43-year-old woman presented with symptoms of acute abdominal pain. At physical examination, a splenomegaly was found in the left hypochondria, thereafter followed by a secondary migration of the lump to a periumbilical location. Computed tomography revealed a wandering spleen with vascular pedicle torsion. Splenopexia was perfomed. CONCLUSION: A wandering spleen is most frequently observed in children and young women. This rare diagnosis should be considered facing a recurrent abdominal pain syndrome, a splenomegaly accompanied with pain, or a pelvic lump. A wandering spleen may lead to torsion of the vascular pedicle of the spleen, a chronic volvulus with portal hypertension, or even a splenic infarction. The diagnosis is performed by computed tomography. Wandering spleen is treated surgically, by splenopexy or splenectomy.

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 and its adherence to the right ovary - An unusual cause of recurrent pain abdomen.

Wandering spleen is a rare condition in which the spleen is hypermobile due to laxity or lack of its supporting ligaments. It can be located anywhere in the abdomen besides its usual position. The other terms that are used to describe this condition are splenic ptosis, displaced spleen, dislocated spleen and ectopic spleen. Splenic torsion is a dreaded complication and the usual cause of symptoms. There is a high chance of missing the diagnosis as it remains asymptomatic or may be incidentally discovered on radio-imaging done for a different purpose. An acute abdomen is the most common presentation. Here we describe an unusual case presenting with torsion of the wandering spleen that was adherent to the right ovary.

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.