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Table of Contents
LETTER TO EDITOR
Year : 2022  |  Volume : 13  |  Issue : 3  |  Page : 201-202

Wandering spleen torsion: A rare case of acute abdomen


Department of General Surgery, Celia Sánchez Manduley Hospital, Manzanillo, Granma, Cuba

Date of Submission10-Feb-2022
Date of Decision11-Feb-2022
Date of Acceptance12-Feb-2022
Date of Web Publication13-Jul-2022

Correspondence Address:
Fernando Karel Fonseca Sosa
Esperanza Street #73 between Guadalupe and San Javier, Manzanillo, Granma, Postal Code 87510
Cuba
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/injms.injms_18_22

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How to cite this article:
Fonseca Sosa FK, Rey Vallés YS. Wandering spleen torsion: A rare case of acute abdomen. Indian J Med Spec 2022;13:201-2

How to cite this URL:
Fonseca Sosa FK, Rey Vallés YS. Wandering spleen torsion: A rare case of acute abdomen. Indian J Med Spec [serial online] 2022 [cited 2022 Aug 9];13:201-2. Available from: http://www.ijms.in/text.asp?2022/13/3/201/350772



Dear Editor,

Wandering spleen (WS) is a rare case in which the spleen is hypermobile in the abdomen due to the absence or laxity of one or all spleen ligaments which fixate the spleen in the left upper quadrant; it may be congenital or acquired and its incidence is less than 0.2%. Due to the hypermobility of the spleen, it is highly prone to torsion causing a life-threatening acute abdomen condition.[1]

We present a case of a 17-year-old male with a history of WS diagnosed 3 months ago by computed tomographic (CT) scan, who came to the emergency department for abdominal pain that began 1 day ago in the mesogastrium and hypogastrium, which intensified progressively, was constant, without irradiation, did not relieve with pain relievers, and increased with the realization of sudden movements. It was accompanied by nausea and vomiting.

On physical examination, the patient had tachycardia of 118 beats/minute. Examination of the abdomen revealed a palpable mass in mesogastrium and hypogastrium, painful on superficial and deep palpation, with muscular defense and slight peritoneal reaction.

Laboratory tests showed leukocytosis (18 × 109/l); the rest of the test were normal. Abdominal ultrasound revealed spleen located in the mesogastrium and hypogastrium measuring 190 mm × 70 mm with abundant fluid in the hypogastrium and perisplenic area. Doppler ultrasound examination showed tortuous vascular pedicle, thrombosis of splenic vein, and reduction of splenic vascular flow.

Urgency intervention was performed by supra–infraumbilical media incision, identifying WS torsion with ischemic areas [Figure 1]. Splenectomy was performed without difficulty. Histology described torsion of the splenic vascular pedicle, with marked vascular congestion, extensive hemorrhagic areas, and areas of infarction. The patient evolved satisfactorily and was discharged on the 5th postoperative day.
Figure 1: Intraoperative picture showing wandering spleen with torsion of the vascular pedicle and ischemic areas

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Acute torsion is the main complication of WS, which occurs due to torsion of the vascular pedicle. It can happen at any age, although it is more frequent in young adult women, mainly multiparous, and in men under 10 years of age.[2]

Symptomatic patients may have different clinical signs and symptoms as reported in the literature, such as acute abdominal pain, vomiting, abdominal distention, constipation, and palpable mass in the abdomen or pelvis, and other signs and symptoms of an acute abdomen may also be present.[3]

Torsion of WS is a rare surgical cause of acute abdominal pain and a radiologist is usually the first to suggest the diagnosis; hence, its awareness is of utmost importance. Diagnostic imaging particularly CT scan is of utmost importance for narrowing the broad possibility for the patient's nonspecific complaint of abdominal pain.[4]

Detorsion and splenopexy may be considered a surgical option even in emergency settings, when there is no evidence of infarction, thrombosis, or hypersplenism, while splenectomy must be reserved to complicated forms of WS when necrosis of the parenchyma is present. According to the scientific community, in case surgery should be performed, laparoscopic approach is the preferred one; therefore, spleen size must be taken into consideration because it has a direct relationship with an increased risk of conversion to open surgery.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

None.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Assaf R, Shebli B, Alzahran A, Rahmeh AR, Mansour A, Hamza R, et al. Acute abdomen due to an infarction of wandering spleen: Case report. J Surg Case Rep 2020;2020:rjz378.  Back to cited text no. 1
    
2.
Rey Vallés YS, Fonseca Sosa FK, Vallés Gamboa M, Quesada Martínez E. Torsion of a wandering spleen. Cir Esp 2020;98:412-9.  Back to cited text no. 2
    
3.
Masroor M, Sarwari MA. Torsion of the wandering spleen as an abdominal emergency: A case report. BMC Surg 2021;21:289.  Back to cited text no. 3
    
4.
Gulati M, Suman A, Satyam M, Garg A. Torsion of wandering spleen and its adherence to the right ovary – An unusual cause of recurrent pain abdomen. J Radiol Case Rep 2020;14:10-8.  Back to cited text no. 4
    
5.
Colombo F, D'Amore P, Crespi M, Sampietro G, Foschi D. Torsion of wandering spleen involving the pancreatic tail. Ann Med Surg (Lond) 2020;50:10-3.  Back to cited text no. 5
    


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