Torsion of a wandering spleen

We present an unusual case of torsion of a wandering spleen in a 14 year old boy. Wandering spleen is an entity which has rarely been reported in infants and children. Although patients may be asymptomatic, some may present as an acute surgical emergency if trauma or torsion of the vascular pedicle occurs, as in our case. The treatment of this condition is splenectomy.     

A 32-year-old woman with chronic abdominal pain

Functional dyspepsia is a highly prevalent disorder that accounts for 5% of visits to primary care clinicians. It frequently coexists with other gastrointestinal tract disorders, including irritable bowel syndrome and gastroesophageal reflux disease. Symptoms of functional dyspepsia, including epigastric pain, early satiety, and postprandial nausea, are nonspecific, making its diagnosis difficult. Functional dyspepsia is a heterogeneous disorder involving a number of different pathophysiologic processes, culminating in both gastrointestinal sensory and motor dysfunction. Although functional dyspepsia does not impart any increased risks to long-term health, it significantly affects both individuals and society. The economic burden of evaluating and treating functional dyspepsia is estimated to be at least $1 billion per year, and patients with functional dyspepsia experience a markedly reduced quality of life. Using the case of Ms C, we apply an evidence-based approach to highlight current knowledge in the diagnosis, evaluation, and treatment of functional dyspepsia.      

Recurrent abdominal pain in children: a clinical approach

The term ‘recurrent abdominal pain’, or RAP, refers mainly to the duration of painful period and frequency of pain. The commonly accepted duration is at least three months in the preceding period, and over this three-month period, there are at least three episodes of pain that are severe enough to affect the daily activities of the affected patients. Over the years, with advances in medical technology and better understanding of the pathophysiology of abdominal pain, more and more organic causes have been identified. However, the most common cause of RAP in children is still functional in origin.     

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.     

Recurrent chylothorax in a woman with primary amenorrhoea.

A 47 year old woman receiving oestrogen replacement therapy for primary amenorrhoea presented with recurrent chylothorax. The clinical and radiological features of her illness were characteristic of pulmonary lymphangio-leiomyomatosis, a rare hormone-dependent disease. The condition was treated with pleurodesis and withdrawal of oestrogen therapy.     

Recurrent Bell's palsy in a young woman

Bell's palsy is a benign lower motor neuron facial nerve disorder. It is almost always unilateral. We report a 20-year-old nulliparous woman with five episodes of recurrent Bell's palsy. A review of recent medical literature revealed a paucity of case reports involving an individual with five episodes of recurrent Bell's palsy, with none found in Asian neurology medical literature. Despite the multiple episodes of Bell's palsy recurrences, the patient did not suffer much neurological sequelae from the disease.     

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.     

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.