Table 1 - uploaded by Salah Termos
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Introduction:
Accessory spleens are found in 10-15% of the population, and are even more prevalent in patients with hematological disorders (Rudowski, 1985). It infrequently may become symptomatic due to torsion, spontaneous rupture or hemorrhage which may lead to death. Torsion of an accessory spleen is extremely rare, and requires prompt medical...
Context in source publication
Citations
... Preservation of the spleen is preferred for children than removing through surgery because the absence of the spleen can make children vulnerable to certain infections. If wandering spleen causes chronic abdominal pain, abnormal enlargement of the spleen, and/or deficiencies of platelets (thrombocytopenia, hypersplenism), the treatment of choice is usually surgery to remove the spleen (splenectomy) [10,11]. Acute abdominal pain associated with a wandering spleen is considered a surgical emergency and may require immediate splenectomy either through laparotomy or laparoscopy [10,12]. ...
... Vascular thrombosis and splenic infarction may follow splenic torsion. Evidenced by fatigue, weakness, lower GI bleeding, anemia, bloody vomit (hematemesis), and/or thrombocytopenia in our patient platelet level was 111,000 cells/μl which suggests vascular thrombosis [11]. ...
Introduction and importance
Wandering spleen may result in torsion or splenomegaly, which causes symptoms such as intestinal obstruction, nausea, vomiting, and swelling in the abdomen. There are few reports of wandering spleen torsion in pregnant mothers. The diagnosis and presentation of splenic torsion is variable and challenging during pregnancy. Herein, we present a case of torsion of a wandering spleen in a 30-year-old pregnant patient.
Case presentation
A 30-year-old female presented with a sudden onset of abdominal pain of three days' duration. There was lower abdominal mass and tenderness. Intraoperative findings revealed enlarged spleen located over the lower abdominal cavity with six times clockwise rotation of the splenic pedicle over itself. A splenectomy was performed. The patient was discharged on the 7th postoperative day and had an uneventful postoperative recovery.
Clinical discussion
Patient presentation could be asymptomatic, chronic left abdominal pain or symptoms and signs of complication. The most common complication of wandering spleen is torsion (Abell, n.d.). Splenic torsion is evidenced by mucosal bleeding, hematemesis, anemia or thrombocytopenia in our patient platelets level was 111,000 cells/μl which suggests vascular thrombosis. The other peculiarity during pregnancy is torsion of the spleen have higher mortality reaching up to 41 % (Lewis and Wolskel, 1962) which may be from delay in diagnosis or misdiagnosis.
Conclusion
There is high mortality associated with splenic torsion in pregnant patient reported in the literature. One of the explanations is misdiagnosis and delay in diagnosis of torsion of a wandering spleen in a pregnant patient.
... 2 Although many conservative methods have been reported for the treatment of wandering spleen, the safest option is accepted to be surgery. 3 Given the high incidence of life-threatening complications, in the case of splenic torsion and infarction in these patients it is very important to promptly recognize this condition and initiate appropriate treatment. In this article, we report a young woman presented with abdominal pain to a remote hospital in Iran. ...
... However, our patient was not multiparous, having only one alive birth and one IUFD. [1][2][3][4][5][6] Others seem to have a hematological underlying disorder, which make them more prone to spleen related diseases, but the patient discussed in our article did not have any previous medical history either, which show that it is important that we have to think of this diagnosis, even in least possible settings. 7 Wandering spleen cases may be asymptomatic unless splenic torsion takes place. ...
... It is able to provide information about the exact location of wandering spleen in relation to other intra-abdominal organs, and viability of the spleen in the setting of a possible splenic torsion, as well. [2][3][4][5][6][7][8][9] Surgical strategy changed over the time; splenectomy was the most reported treatment, but nowadays splenopexy is considered to be the optimal treatment for the non-infarcted wandering spleen to avoid post-splenectomy sepsis, however; many considerations have to be noted. A key consideration is the vascular status of spleen. ...
Key Clinical Message
Wandering spleen results from abnormal ligamentous laxity and is often symptomatic, presented with abdominal pain and other non‐specific symptoms. These symptoms, make the diagnosis very difficult and most of the times even impossible. As such, keeping in mind this pathology, can make further complications less frequent.
... In this case, the size of the accessory spleen at the time of resection was 24 mm. Termos et al. [11] found that accessory spleens larger than 6 cm were more prone to torsion. However, Ozeki et al. [12] reported torsion of a 30-mm accessory spleen. ...
Introduction
Accessory spleen torsion is extremely rare, and surgery is often the emergency or elective treatment of choice.
Presentation of case
A 20-year-old female with no specific medical history presented to our outpatient clinic with a chief complaint of abdominal pain. The patient was diagnosed with accessory spleen torsion by computed tomography. However, the abdominal symptoms and inflammatory reaction based on blood tests were mild, so a conservative treatment was selected. Subsequently, blood tests were normalized, and imaging studies showed that the accessory spleen was shrinking. Contrast-enhanced examination showed contrast enhancement in a portion of the infarcted accessory spleen region, indicating that the accessory spleen torsion had been released. Surgical resection was performed to prevent possible future re-torsion and hemorrhage of the accessory spleen.
Discussion
The removed specimen seemed to be normal accessory spleen tissue with clear infarcted foci edges. This artery showed evidence of luminal organization and untwisting of the occluded artery.
Conclusion
This accessory spleen torsion was treated conservatively; however, the patient was referred for surgical treatment.
... A wandering spleen presents in varying forms, such as an incidentally detected radiological mass, an asymptomatic mobile intra-abdominal mass, or (as in the present case) after severe pain secondary to torsion (4,5). Treatment options primarily include splenopexy and splenectomy; however, splenectomy has a relatively high risk of complications, such as postsplenectomy sepsis (6)(7)(8). ...
We herein report a rare case of torsion of a wandering spleen in a patient with myeloproliferative disease. A 66-year-old Japanese woman presented to our hospital with abdominal pain and a fever. She had a medical history of polycythemia and secondary myelofibrosis. Abdominal enhanced computed tomography showed an enlarged spleen without enhancement in the lower pelvic region. The clinical diagnosis was severe torsion of a wandering spleen in a patient with myeloproliferative disease, necessitating surgical intervention. Splenectomy was performed after de-rotating to revascularize the spleen. After the operation, the platelet count gradually increased, and aspirin was administered to prevent thrombosis.
... This condition is very rare, with an incidence of less than 0.2% [2], and makes susceptible the spleen to acute torsion and infarction with splenic vein obstruction, leading to the formation of gastric varices [3]. Although many conservative treatment options have been reported for the treatment of wandering spleen, the most effective and safest option is accepted to be surgery [4]. ...
The spleen is an organ located in the upper left portion of the abdomen. Wandering spleen is defined as the location of the spleen is the shift to other parts of the abdomen rather than the left upper quadrant. Wandering spleen is a rare clinical condition and can lead to hilar torsion and subsequent infarction requiring emergency surgery. The author presents a case of torsion of a wandering spleen in a 34-year-old female presenting with abdominal pain. The patients underwent emergent laparoscopic splenectomy. She had an uncomplicated postoperative course and recovered well.
... While accessory spleens are typically incidental lesions, they do need to be reported in certain conditions, such as in immune thrombocytopenic purpura, as failure to remove the accessory splenules at the time of splenectomy may result in recurrence of the condition. Rarely, accessory splenules may undergo complications such as torsion or infarction [10,11]. On contrast-enhanced CT, a torsed accessory spleen appears as a non-enhancing, wellcircumscribed soft tissue mass with surrounding hemorrhage or edema from venous congestion due to torsion at the vascular pedicle. ...
The perisplenic region is a complex anatomical area involving multiple peritoneal and subperitoneal structures, which influence the presentation and behavior of various pathologic processes. This review is a comprehensive resource for perisplenic anatomy and pathology with associated clinical presentations and imaging findings. Understanding the pathophysiologic intricacies of the perisplenic region assists the radiologist in building a helpful differential diagnosis and recognizing predictable disease patterns.
... Peripheral or focal calcifications are uncommon, occurring in 10% to15% of cases; however, they can be seen in complex cases [17]. CT scanning and magnetic resonance imaging can give detailed information regarding the morphology of the cyst as well as its exact dimensions and relation to the hilum and surrounding structures [18,19]. ...
Patient: Female, 22-year-old
Final Diagnosis: Primary nonparasitic splenic cyst
Symptoms: Abdominal pain • mass in abdomen
Medication: —
Clinical Procedure: Laparoscopic decapsulation of giant splenic cyst.
Specialty: Surgery
Objective
Rare disease
Background
Primary nonparasitic splenic cysts (PNSC) are unusual epithelial fluid lesions of the spleen. They are considered congenital cysts and are often discovered incidentally in young people. Larger cysts can be symptomatic and are traditionally managed with splenectomy. This report is of a woman with a large symptomatic PNSC that was managed surgically by laparoscopic decapsulation.
Case Report
A 22-year-old Lebanese woman presented with left upper-quadrant pain, left pleuritic pain, food intolerance, and significant weight loss. Investigations showed a 20×17×15 cm cystic lesion in the spleen. Secondary causes were ruled out and tumor marker and hydatid serology were unremarkable. Laparoscopic decapsulation of the cyst with spleen preservation was performed with no perioperative complications. The patient’s 3-year follow-up visit revealed no clinical or radiological recurrence.
Conclusions
True congenital splenic cysts are rare clinical findings. Generally, they do not have malignant potential. The development of minimally invasive techniques has shifted the trend toward splenic salvaging procedures. Literature review revealed an acceptable recurrence rate with near-total rather than partial unroofing. Laparoscopic decapsulation can be a safe and adequate therapeutic option in selected cases.
... These complications are often acute and life-threatening, with the most common being the torsion of the spleen, which is also the main reason for the patients' presentation to the hospital with acute abdominal findings (3,4). Although many conservative methods have been reported for the treatment of wandering spleen, the safest option is accepted to be surgery (5). We discuss a case that presented to our clinic with acute abdominal findings after the torsion of wandering spleen. ...
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.
... Laparoscopy has been tailored to resect smaller sized accessory spleens, diagnosed preoperatively, and has been gradually modified to resect larger accessory spleens. [9] In our case, the accessory spleen was 4.5 cm, larger than usual, and considered a risk of torsion. The initial US image showed marginal hyperechoic areas of the mass with internal hypoechoic areas without blood flow. ...
We report a case of a 12-year-old boy with an accessory spleen torsion. He presented with left-sided abdominal pain after trauma. A 4 cm oval mass without contrast enhancement was detected on contrast-enhanced computed tomography (CT), and ultrasound (US) showed a 4 cm oval mass below the spleen. The mass mainly consisted of high echoes similar to the spleen; the central part showed irregularly low echoes. Subsequent follow-up daily US examinations showed gradual expansion of the central low echoes with conspicuous hyperechoic dots. Discontinuation of the branch from the splenic artery to the mass was observed, both, on US and CT. These findings led to the diagnosis of a hemorrhagic infarct caused by torsion of the accessory spleen. Laparoscopy showed adherence of the accessory spleen to the omentum and colon by twisting four times around its axis. It was resected and confirmed the diagnosis of a torsioned accessory spleen.
... 1-12 Very rare cases have been described in younger patients and children. [1][2][3][4][5][6][7][8][9][10][11][12]14 The incidence of this condition in pediatric patients have not been fully elucidated yet although it has been estimated that less than 0.2 % of patients who undergo splenectomy carry this diagnosis as their surgical indication. 7,10,11 The standard of care for patients with splenic torsion is surgery, either splenopexy or splenectomy, depending on the viability of the spleen. ...
Wandering spleen, otherwise known as ectopic spleen, is a rare congenital or acquired condition, especially in pediatric patients, characterized by elongated splenic pedicle due to congenital or acquired laxity of suspensory splenic ligaments resulting in exaggerated splenic mobility that predisposes it to torsion and often to subsequent infarction. We present a case of a 1-year old Caucasian female who presented with acute abdomen showing infarcted ectopic spleen on imaging. Most patients with infarcted spleen require surgery as the standard intervention. However, our patient was managed medically and had an excellent outcome in the absence of surgery.
