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Cui Q, Xu X, Li C, Tang L. Wandering spleen combined with pedicle torsion and splenic infarction: a rare case report and literature review. Front Pediatr 2024; 12:1429490. [PMID: 39350792 PMCID: PMC11439698 DOI: 10.3389/fped.2024.1429490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/12/2024] [Indexed: 10/04/2024] Open
Abstract
Wandering spleen (WS) concurrent with splenic pedicle torsion and infarction has been described rarely. We reported our experience in diagnosing and treating such a condition in a 16-year-old girl with acute abdominal pain. A plain CT scan showed the wandering of the spleen from the left upper quadrant. Contrast-enhanced CT indicated dilatation and distortion in the splenic vein, a counterclockwise "whirl sign" in the splenic pedicle, pancreatic tail torsion, and splenic infarction. The patient was diagnosed with WS combined with splenic pedicle torsion and splenic infarction and underwent splenectomy for treatment. She showed a satisfactory outcome during the follow-up. To enhance our understanding of it, we performed a comprehensive literature research to summarize the clinical manifestations, treatment options, and outcomes among adolescent patients.
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Affiliation(s)
- Qian Cui
- Department of Radiology, Shaoxing Central Hospital, Shaoxing, China
| | - Xiaoyan Xu
- Imaging Center, Tengzhou Central People’s Hospital, Tengzhou, China
| | - Chang Li
- Department of Pathology, Tengzhou Central People’s Hospital, Tengzhou, China
| | - Lihao Tang
- Imaging Center, Tengzhou Central People’s Hospital, Tengzhou, China
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Johan MNSC, Zain WZW, Zakaria AD, Bibi S. Massively enlarged wandering spleen with ruptured epidermoid cyst. GULHANE MEDICAL JOURNAL 2024:104-107. [DOI: 10.4274/gulhane.galenos.2023.72677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2024]
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Makhoul E, Harb M, Makhoul S. Primary hydatid cyst of the spleen: A rare case report and literature review. Arab J Gastroenterol 2024; 25:230-233. [PMID: 38238228 DOI: 10.1016/j.ajg.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/28/2023] [Accepted: 11/11/2023] [Indexed: 06/03/2024]
Abstract
Hydatidosis is an endemic disease in certain areas in the world particularly in the Mediterranean, the Middle East, and South America, caused by a cestode known as Echinococcus granulosus. Humans are the accidental intermediate hosts. The liver and the lungs are the most commonly involved organ. If the parasite passes through the pulmonary capillary bed, the hydatid cyst may develop at any site in the body like bone, pancreas, brain, kidney, and orbit. Isolated spleen hydatid cyst is very rare. We hereby report one observation of isolated hydatid cyst of the spleen in a patient living in non-endemic area and without any potential risk.
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Affiliation(s)
- Elias Makhoul
- Department of Gastroenterology, University Hospital Notre Dame de Secours, Byblos, Lebanon; School of Medicine and Sciences Medical Holy Spirit University of Kaslik, Lebanon; Pole of Gastroenterology, Polyclinic du Parc Maubeuge, France.
| | - Marc Harb
- Department of Gastroenterology, University Hospital Notre Dame de Secours, Byblos, Lebanon; School of Medicine and Sciences Medical Holy Spirit University of Kaslik, Lebanon; Pole of Gastroenterology, Polyclinic du Parc Maubeuge, France
| | - Selim Makhoul
- Department of Gastroenterology, University Hospital Notre Dame de Secours, Byblos, Lebanon; School of Medicine and Sciences Medical Holy Spirit University of Kaslik, Lebanon; Pole of Gastroenterology, Polyclinic du Parc Maubeuge, France
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Lim Y, Leng H, Lee CH, Chhun V, Lee YD. A congenital wandering spleen with a large epithelial cyst: A case report. Clin Case Rep 2022; 10:e6559. [PMID: 36381033 PMCID: PMC9653159 DOI: 10.1002/ccr3.6559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/06/2022] [Accepted: 10/15/2022] [Indexed: 11/13/2022] Open
Abstract
We present a case of a 21-year-old female patient who had a wandering spleen with a large cyst. The celiotomy was performed under the impression of torsion of the wandering spleen and leakage from the splenic cyst. The total splenectomy was performed instead of cystectomy and splenopexy.
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Affiliation(s)
- Youhok Lim
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Hour Leng
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
| | - Chi Hoon Lee
- Department of Education & TrainingHebron Medical CenterPhnom PenhCambodia
| | - Vireak Chhun
- Department of PathologyHebron Medical CenterPhnom PenhCambodia
| | - Young Don Lee
- Department of SurgeryHebron Medical CenterPhnom PenhCambodia
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Sun C, Li SL. Successful treatment of floating splenic volvulus: Two case reports and a literature review. World J Clin Cases 2021; 9:8812-8819. [PMID: 34734060 PMCID: PMC8546827 DOI: 10.12998/wjcc.v9.i29.8812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The floating spleen refers to the spleen moving away from the normal anatomical position to other parts of the abdominal cavity.
CASE SUMMARY In this report, we describe two cases of torsion of floating spleen, which were successfully treated by laparoscopic partial splenectomy and retroperitoneal fixation of the residual spleen. The clinical characteristics of previously reported cases are also discussed.
CONCLUSION In conclusion, laparoscopic partial resection of splenic volvulus infarction and extraperitoneal fixation of residual spleen are safe and reliable.
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Affiliation(s)
- Chi Sun
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Suo-Lin Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Ganarin A, Fascetti Leon F, La Pergola E, Gamba P. Surgical Approach of Wandering Spleen in Infants and Children: A Systematic Review. J Laparoendosc Adv Surg Tech A 2021; 31:468-477. [PMID: 33428514 DOI: 10.1089/lap.2020.0759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction: Splenopexy has been proposed as the treatment of choice in case of wandering spleen (WS). We report our experience and review the current literature focusing on surgical management and outcomes of children affected by WS. Materials and Methods: Data regarding demographics, clinical manifestations, diagnosis, and treatment of children treated for WS at our Institution were analyzed. Systematic review was registered on Prospero (CRD42018089971). Scientific databases were searched using defined keywords. Articles were selected using predefined exclusion and inclusion criteria. Analysis was conducted adding our center's cases. Results: One hundred sixty-six articles were included in the review, 197 cases were analyzed, 3 of which unpublished. Female/male ratio was 1.5:1 and median age at diagnosis was 8 years. Most frequent clinical manifestation was isolated abdominal pain (42.6%). Torsion of splenic pedicle was diagnosed in 56.3%. Among surgical procedures, 39% underwent splenopexy and 54.8% underwent splenectomy. In case of splenopexy, the most commonly used techniques were using of a mesh (45.5%) or creation of a retroperitoneal pouch (30.9%). In 48.2% of splenopexies, minimally invasive surgery (MIS) was used. Splenopexy was effective in 94.8% (88% considering only cases with a spleen torsion). Conclusion: WS is a rare condition potentially leading to torsion of the spleen. This entity has to be kept in mind as a differential diagnosis in case of abdominal pain. Splenopexy should be the treatment of choice; its success rate in terms of preserved spleens can be affected by the presence of a torted organ. Retroperitoneal pouch or mesh fixation are the most preferred techniques. Authors recommend MIS approach.
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Affiliation(s)
- Alba Ganarin
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Francesco Fascetti Leon
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Enrico La Pergola
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
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Alqadi GO, Saxena AK. Is laparoscopic approach for wandering spleen in children an option? J Minim Access Surg 2018; 15:93-97. [PMID: 29737310 PMCID: PMC6438076 DOI: 10.4103/jmas.jmas_14_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aim: Wandering spleen present generally as an acute abdomen after twisting of the splenic vascular pedicle. This study aimed to review the literature with regard to the management and outcomes of the laparoscopy in children with wandering spleen. Methods: The literature was reviewed for articles on PubMed with regard to the following search terms ‘laparoscopy’, ‘wandering’, 'spleen’ and ‘children’. The inclusion criteria included article only in the paediatric age group of 0–16. Articles that did not meet the inclusion criteria were excluded from the study. Results: The PubMed search from 1998 to 2016 identified 15 articles. There were 20 children with an age range from 2 to 16 years who underwent the laparoscopic procedure for wandering spleen. The median age was 8 years. Associated conditions were present in 45% of patients: gastric volvulus (n = 3), torsion of the distal pancreas (n = 3), splenic cyst (n = 2), mental retardation and myotonic dystrophy (n = 1). In two cases, the spleen was twisted around the pedicle and was non-viable, and therefore, a splenectomy was performed. Other 18 cases were managed by splenopexy using a 3–5-port technique. An extraperitoneal pocket was created using a balloon device in five patients. Fixation of the spleen was performed using a mesh in 10 cases and omentum in three cases. In one case, additional support was created by plicating the phrenicocolic ligament. Simultaneous gastropexy was performed in four patients. There were no post-operative complications. Conclusions: Wandering spleen is a rare entity and in the paediatric age group 10% cannot be salvaged for which splenectomy is the only option. Of the 90% that can be pexied, the literature has favoured the application of meshes followed by the extraperitoneal pockets and omental pouch. Laparoscopic splenopexy is feasible, with no reported conversions or complications.
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Affiliation(s)
- Gratiana Oana Alqadi
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, United Kingdom; Department of Paediatric Surgery, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Amulya K Saxena
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, United Kingdom
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Splenic torsion presenting as splenic vein thrombosis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Torri F, Parolini F, Vanzetti E, Milianti S, Cheli M, Alberti D. Urgent laparoscopic mesh splenopexy for torsion of wandering spleen and distal pancreas: A case report. Asian J Endosc Surg 2015; 8:350-3. [PMID: 26303736 DOI: 10.1111/ases.12188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/08/2015] [Accepted: 02/25/2015] [Indexed: 12/12/2022]
Abstract
Wandering spleen is a condition in which an incomplete fusion of the splenic ligaments allows the spleen to move within the abdomen, predisposing it to splenic torsion along its vascular pedicle. Torsion of a wandering spleen is an uncommon occurrence, especially in children, and associated torsion of the distal pancreas is even more unusual, with only four cases having been reported in adults. Non-specific clinical presentation makes radiologic evaluation essential in order to obtain a diagnosis and to send the patient for early surgery before life-threatening complications arise. Here we present a rare case of torsion of wandering spleen together with volvulus of the distal pancreas in a 13-year-old girl. In this case, prompt radiological assessment allowed for an early diagnosis, and the patient was successfully treated with urgent laparoscopic derotation of both the spleen and the distal pancreas as well as mesh splenopexy. To the best of our knowledge, this procedure has never been described in a pediatric setting.
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Affiliation(s)
- Fabio Torri
- Department of Paediatric Surgery, Azienda Ospedaliera Spedali Hospital, Brescia, Italy
| | - Filippo Parolini
- Department of Paediatric Surgery, Azienda Ospedaliera Spedali Hospital, Brescia, Italy
| | - Enrico Vanzetti
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Susanna Milianti
- Department of Paediatric Surgery, Azienda Ospedaliera Spedali Hospital, Brescia, Italy
| | - Maurizio Cheli
- Department of Paediatric Surgery, Azienda Ospedaliera Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Daniele Alberti
- Department of Paediatric Surgery, Azienda Ospedaliera Spedali Hospital, Brescia, Italy.,University of Brescia, Brescia, Italy
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Sheikh F, Kim ME, Zamora IJ, Olutoye OO. Non-operative management of a rare diagnosis of splenic torsion in a child with a history of giant omphalocele: a case report and literature review. Patient Saf Surg 2014; 8:12. [PMID: 24602190 PMCID: PMC3973840 DOI: 10.1186/1754-9493-8-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Splenic torsion is rare and as a result the appropriate management is unclear. While there has been a shift towards splenectomy and laparoscopic splenopexy, we present a successful case of non-operative management of splenic torsion in a patient with a history of a giant omphalocele. CASE PRESENTATION A 3 year-old female presented with a three-day history of abdominal pain, fever and non-bloody emesis three and a half years after repair of her giant omphalocele. Abdominal radiographs and ultrasound demonstrated migration of the spleen and a subsequent computerized tomography scan confirmed splenic torsion and an infarcted spleen. Given her late presentation, she was successfully managed with observation, analgesia, immunization against capsulated organisms and daily penicillin prophylaxis with excellent outcome at 19 months follow-up. A review of the literature revealed that splenic torsion is rarely managed non-operatively. Rarer still is the occurrence of splenic torsion following a history of omphalocele. CONCLUSION Although rare, splenic torsion should be considered in a child with a history of omphalocele presenting with abdominal pain. Non-operative management of an infarcted spleen can be a safe treatment option to avoid surgery in complex patients.
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Affiliation(s)
| | | | | | - Oluyinka O Olutoye
- Division of Pediatric Surgery, Michael E DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston TX, USA.
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Okazaki T, Ohata R, Miyano G, Lane GJ, Takahashi T, Yamataka A. Laparoscopic splenopexy and gastropexy for wandering spleen associated with gastric volvulus. Pediatr Surg Int 2010; 26:1053-5. [PMID: 20625747 DOI: 10.1007/s00383-010-2657-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Wandering spleen is not a common condition in childhood and has been described only rarely in association with gastric volvulus. The authors report the successful management of wandering spleen associated with gastric volvulus using laparoscopic splenopexy and gastropexy in a 4-year-old girl.
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Affiliation(s)
- Tadaharu Okazaki
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan.
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Kuwatani M, Kawakami H, Haba S, Eto K, Onodera M, Asaka M. A wandering pancreatic mass. Intern Med 2010; 49:627-8. [PMID: 20228606 DOI: 10.2169/internalmedicine.49.3235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Masaki Kuwatani
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo.
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