Torsion of a wandering spleen: A rare cause of acute abdomen

Wandering spleen is a rare condition that accounts for less than 0.25% of all indications for splenectomy. It is characterized by ectopic localization of the spleen owing to the lack or weakening of its ligaments. Torsion is the most common complication due to its long pedicle and high mobility, which may result in acute abdomen. We report a case of torsion in a wandering spleen in a 28-year-old male presenting with an acute abdomen that was treated by splenectomy.Wandering spleen is a rare condition, which may be incidentally detected as an abdominal mass or can present with torsion of its pedicle causing an acute abdomen. Alternative names are: ectopic spleen, displaced spleen, floating spleen, or pelvic spleen. It is characterized by the absence or underdevelopment of one or all ligaments that hold the spleen in its normal anatomical position in the left upper quadrant of the abdomen.1 It mainly affects children (one-third of cases), with a female predominance after age one.2 Among adults, it most frequently affects women of reproductive age, in whom acquired laxity of the splenic ligaments is usually the cause.2 Due to lack of specific symptoms, diagnosis is difficult, unless there is torsion, presenting as acute abdomen. Radiological imaging is required to make diagnosis; treatment is either splenopexy or splenectomy. We report a case of torsion of wandering spleen in a 28-year-old male presenting with an acute abdomen, which was treated by splenectomy.     

Wandering spleen with chronic torsion in a patient with thalassaemia

Wandering spleen or splenoptosis is an uncommon entity and often an asymptomatic finding of acute abdomen in the emergency department. A high index of suspicion for splenic torsion is required, particularly in patients with known splenomegaly, as this condition could potentially lead to splenic infarction. Recognition of this condition can help avoid potential confusion with acute abdomen of other aetiologies. Herein, we present a unique case of wandering spleen with chronic torsion, which, to the best of our knowledge, has never been described in an elderly patient with haemoglobin H thalassaemia. We also review the literature for the aetiology and pathogenesis of wandering spleen, and discuss the relevant diagnostic modalities and treatment options.     

A case of wandering spleen: a rare cause of acute abdomen

We present the case of a 17-year-old patient known to have an asymptomatic ectopic spleen, who presented with an acute abdomen. Clinical symptoms and ultrasound led to suspect an acute appendicitis, confirmed later on by pathology. Twenty-four hours after the appendectomy, the patient complained of an abdominal pain of acute onset. Torsion of the pedicle of the ectopic spleen was suspected. Imaging studies supported this diagnosis, and an urgent splenectomy was performed. Did the torsion happen by simple coincidence 24 hours after appendectomy, knowing that the spleen has been asymptomatic for 17 years, or was it precipitated by the surgical intervention? Should we have removed the ectopic spleen during the appendectomy? This is the first report of a case of torsion of a wandering spleen after a laparotomy; a review of the literature is done in order to explain the physiopathology of the disease, and to propose its management.     

Acute torsion of a wandering spleen

The 'wandering spleen' is a rare condition due to extreme laxity or absence of ligaments that fix the organ in its normal anatomical position within the left upper quadrant. Without early surgical intervention, wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important, so as to salvage the spleen and prevent complications. We present a case of torsion of a wandering spleen in a 21-year-old young woman, who presented with a painful pelvic mass. We also reviewed the literature on this entity.     

Splenic pseudocyst: a rare association with splenoptosis and vertebral segmentation anomalies

Splenoptosis (wandering or ectopic spleen) is a congenital fusion anomaly of the dorsal mesogastrium in which the spleen is abnormally mobile due to its attachment by a long vascular pedicle. This abnormal mobility predisposes the spleen to complications such as torsion, infarction, gangrene and pancreatic necrosis. Pseudocyst formation is one of the rarely reported complications of splenoptosis. Few cases of splenoptosis associated with vertebral segmentation anomalies have been reported in the past. Here, we present the case of a young man with kyphoscoliosis, vertebral segmentation anomalies and splenoptosis complicated by pseudocyst formation.     

Wandering spleen presenting as a right hypochondrial mass and intestinal obstruction

This is a case report of a 23 year old multiparous woman who presented with intestinal obstruction and a right hypochondrial mass. Laparatomy revealed an infarcted 1.4 Kg spleen in the right lumbar region compressing the ascending colon. There was also ileal volvulus around the splenic pedicle. This is probably the first documented case of wandering spleen in the right hypochondrium, presenting as right large bowel obstruction, to be reported in our region. Wandering spleen is a rare condition, often asymptomatic, but may present as an acute abdomen. Pre-operative diagnosis is difficult and rarely made. Laboratory tests are seldom useful, but imaging studies do assist. Up to 1971 only 350 cases had been reported in the western literature. Review of English literature from 1900 to 1991 reported only 51 cases in children. In our region 11 cases were reported in Uganda between 1968 and 1971. No other literature is available from our region. Clinical presentation, aetiology, investigation, and management of wandering spleen is discussed.     

Intermittent omental torsion--an unusual cause of recurrent abdominal pain?

A case of haemoperitoneum arising from an omental haematoma is described. Histology suggests that this resulted from an omental torsion. The omentum, however, was not torted at the time of laparotomy. Furthermore, there was a history of similar episodes of pain over the previous eighteen months. This suggests that spontaneous derotation of an omental torsion may occur, and may be an unusual cause of recurrent abdominal pain.     

Primary omental torsion in a child: mimic acute appendicitis

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Solitary cyst of the liver presenting as an abdominal emergency

A case of torsion of a solitary non-parasitic cyst of the liver presenting as an acute abdominal emergency is described. Reference is made to the pathogenesis of such cysts, which occur infrequently and only rarely present with complications. A review of previous reports of complications in such cysts is presented.     

Torsion of a wandering spleen with whorled appearance of the splenic hilum in CT scan

An eight-year-old boy admitted for acute abdominal pain was diagnosed to have torsion of the spleen (TS) based on contrast enhanced computerised tomography (CECT) of the abdomen. CECT showed whorled appearance in the splenic hilum. Whorl sign' refers to the presence of a twisted splenic pedicle intermingled with fat, resulting in alternating circular bands of radiodensity and radiolucency and is considered diagnostic of TS. This is the fourth reported case of whorl sign in children with TS and the first from Malaysia.     

B型超声在女性盆腔疼痛诊断中的应用价值

目的探讨B型超声在女性盆腔疼痛诊断中的应用价值。方法对90例盆腔疼痛女性患者行B型超声检查。结果宫外孕35例，宫内早孕5例，宫内早孕并卵巢囊肿蒂扭转4例，宫内早孕并畸胎瘤2例，卵巢巧克力囊肿20例，子宫肌瘤3例，输尿管结石15例．阑尾炎6例。结论B型超声对女性盆腔疼痛疾病可快速做出诊断，为临床诊断提供可靠信息，可成为第一线诊断工具。     

Torsion of parovarian cyst--report of two cases

A parovarian cyst oxiginates from the tissue of the broad ligament, predominantly from mesothelium covering the peritoneum but also from paramesonephric and mesonephric remnants. Clinically, torsion of a parovarian cyst is uncommon, and it is difficult to distinguish it from torsion of other adnexal masses, an ovarian accident, appendicitis, etc. Recently, we experienced two cases of torsion of parovarian cysts. In one case, it was associated with 32 weeks' intrauterine gestation. In this case, pelvic sonography during the first and second trimester showed no cystic lesions. In the other case, a lower abdominal pain continued about two weeks. A sonogram revealed a very small cyst like a follicle. These twisted parovarian cysts were removed at laparotomy. The clinical and pathological features of the torsion of parovarian cysts are briefly discussed and the literature is reviewed.     

螺旋CT在老年人急腹症诊断中的应用价值

目的探讨螺旋CT在老年人急腹症诊断中的应用价值。方法回顾性分析我院自2006年6月至2009年6月收治的128例≥60岁的老年急腹症患者的影像资料及临床资料。结果128例中,感染性急腹症77例,梗阻性急腹症39例,穿孔性急腹症7例,肠系膜上静脉栓塞1例,卵巢囊肿蒂扭转2例,肺部感染引起急腹症1例,脾梗塞1例。其中经手术病理证实76例,其余52例经临床证实。结论螺旋CT在老年人急腹症诊断尤其病因诊断中具有重要价值。     

Asynchronous ovarian torsion--the case for prophylactic oophoropexy.

The case of an 11 year old girl who suffered torsion of the left ovary 8 months following right oophorectomy for a similar event is presented. The left ovary was saved by immediate surgical intervention. The value of prophylactic oophoropexy in unilateral ovarian torsion is discussed.     

Recurrent abdominal pain in a woman with a wandering spleen

A 28-year-old Malay woman presented with recurrent abdominal pain for five years. She had delivered her child seven months earlier. She was found to have bicytopenia, with a haemoglobin level of 7.9 g/dL and a platelet count of 85 x 10(9)/L. Computed tomography revealed a wandering spleen. Complications of a wandering spleen, for which splenectomy is advocated, include functional asplenia (due to torsion of the splenic pedicle), splenic infarction or splenic vessel thrombosis. A splenectomy was performed and at operation, splenomegaly with a long mesentery was found. Splenic histology was negative for malignancy. The bicytopenia resolved postoperatively, and she remains well.     

急性睾丸扭转的诊断和治疗

目的:探讨急性睾丸扭转的诊断和治疗。方法:回顾性总结分析12例急性睾丸扭转患者的临床资料。结果:12例患者均经彩色多谱勒血流成像检查,11例确诊为睾丸扭转,2例行手法复位成功,1例自动复位,2例手术复位成功,7例手术切除坏死睾丸。结论:彩色多谱勒血流成像是诊断急性睾丸扭转的可靠方法,早期诊断,早期复位是提高睾丸成活率的关键。     

Infarcted accessory spleen due to segmental portal hypertension

Accessory spleens are frequent entities, but their infarction due to arterial stasis caused by segmental portal hypertension is extremely rare. We present this case of a 38-year-old female patient with a three-week history of abdominal pain and an abdominal CT scan revealing a 7 cm mass near the spleen and tail of pancreas with segmental portal hypertension. The patient had no hematologic disease. This mass was surgically resected, with a pathological diagnosis of an infarcted accessory spleen.     

Wandering spleen with torsion of the pedicle

Wandering spleen is a rare medical entity. It usually occurs at 20-40 years of age, and most cases are seen in women. Clinical diagnosis is difficult due to lack of symptoms, unless splenic torsion has occurred and clinical symptomatology of acute abdomen develops. The diagnosis can be confirmed by imaging techniques. Treatment is operative due to complications of splenic infarction. Splenopexy is the usual treatment, except for cases of splenic infarction. Splenectomy should be carried out when there is no evidence of splenic blood flow after detorsion of the spleen and in cases of excessive splenomegaly.     

睾丸扭转8例临床分析

目的 提高睾丸扭转的诊治水平。方法 回顾性分析8例睾丸扭转患者的临床资料。结果 5例首诊时误诊为急性附睾炎,7例经阴囊彩超确诊,1例经手术探查确诊。8例均予以手术治疗,6例行患侧睾丸切除,2例保留患侧睾丸,而对侧睾丸均行预防性固定。随访一年,2例保留的睾丸未发现萎缩及再次扭转,对侧睾丸均无扭转发生。结论睾丸扭转和急件附睾炎在临床表现上难以鉴别,彩超检查为确诊的首选方法。一旦疑诊睾丸扭转均应手术探查,以提高睾丸的存活率。     

Torsion of an accessory spleen in an elderly patient

Torsion of an accessory spleen is recognized as a rare cause of acute abdominal pain in childhood. A case is reported which, however, is unusual in that it occurred in a patient of 75, who had had no previous symptoms which might have suggested the presence of an accessory spleen.