Cases reported "Wandering Spleen"

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1/8. The technique of laparoscopic retroperitoneal splenopexy for symptomatic wandering spleen in childhood.

    BACKGROUND: wandering spleen is an uncommon diagnosis, difficult to prove by standard investigations. The authors report a new method for laparoscopic splenopexy in children using a balloon-dilated retroperitoneal pouch. methods: From 3 accesses, the spleen is mobilized and displaced into a retroperitoneal pouch dilated to the double splenic volume. The pouch is dilated by a self-made balloon via a further intercostal access and narrowed by sutures incorporating the cranial and caudal edge of the gastrosplenic ligament. RESULTS: The peritoneal pouch contracts around the retroperitoneal spleen resulting in a firm fixation of the organ. This technique was successful in a 9-year-old girl with a 5-year history of severe recurrent abdominal pain. CONCLUSIONS: Laparoscopic retroperitoneal pouch splenopexy is a safe and effective procedure for symptomatic wandering spleen precluding the use of foreign materials in this age group. ( info)

2/8. Laparoscopic pocket splenopexy for wandering spleen: a case report.

    wandering spleen is a very uncommon condition. Because of the risk of pedicle torsion and splenic ischemia, severe consequences may occur if not diagnosed and treated in time. Unfortunately, splenectomy is sometimes necessary (ie, when splenic infarction occurs). Once the diagnosis of wandering spleen is made, splenopexy is the treatment of choice. There are numerous techniques designed for splenopexy, either by open surgery or by minimally invasive approaches. We describe here a laparoscopic procedure that allows an excellent fixation of the spleen using the patient's own tissues. After a 2-year follow-up, the organ remains in place with good perfusion. ( info)

3/8. Pseudocyst formation: a rare complication of wandering spleen.

    wandering spleen is a rare entity, in which the spleen is abnormally mobile due to its attachment by a long vascular pedicle. This long vascular pedicle predisposes it to various complications, the most common being torsion. Here, we present a case in which a wandering spleen in a young female was complicated by pseudocyst formation, and discuss the possible aetiology, pathogenesis, diagnosis and therapeutic implications of this extremely rare complication. ( info)

4/8. wandering spleen--the challenge of ultrasound diagnosis: report of 7 cases.

    PURPOSE: To summarize our experience with sonographic diagnosis of wandering spleen in children and assess for the typical sonographic findings of wandering spleen, complications, and possible diagnostic pitfalls. methods: We identified all pediatric patients from 1998-2003 with a surgically confirmed diagnosis of wandering spleen. All sonographic examinations were reviewed for splenic position, size, echotexture, and parenchymal blood flow. RESULTS: Seven children were identified with a mean age of 9.7 years (range 4.2-15.3 years). All presented with abdominal pain. Abdominal sonography, performed in all children demonstrated a low position of the spleen (n = 6), splenomegaly (n = 4), and absence of parenchymal flow in the three patients with splenic torsion and infarction. The diagnosis was made preoperatively via sonography in five children; three required repeated hospital admissions before the correct diagnosis was established. Complications occurred in five patients (gastric obstruction [n = 1], splenic infarction [n = 3], and recurrent pancreatitis [n = 1]). CONCLUSION: The most specific sonographic finding for wandering spleen is low position of the spleen. However, if the spleen regains its normal or near-normal position, the diagnosis may be missed and the condition may recur, and result in complications. ( info)

5/8. wandering spleen with torsion and gastric volvulus.

    wandering spleen, defined as a spleen without its usual peritoneal attachments, is a rare entity, particularly in children. It usually occurs in those aged 20 to 40 years, and most cases occur in women. patients usually become symptomatic when torsion of the splenic pedicle occurs. Gastric volvulus, like wandering spleen, is also related to anomalies of intraperitoneal visceral attachments. However, cases of wandering spleen associated with gastric volvulus are rare. We report a case of wandering spleen with torsion and gastric volvulus. The patient was a 4-year-old girl who presented with acute intractable vomiting and abdominal pain. Exploratory laparotomy was performed under the impression of wandering spleen with torsion. The gastric volvulus was found intraoperatively. Following splenectomy and gastropexy, haemophilus influenza type b and pneumococcus vaccination and prophylactic antibiotics were given. She recovered uneventfully and had no signs of illness or ongoing infection at 1-year follow-up after the operation. ( info)

6/8. 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. ( info)

7/8. An unusual case of hemoperitoneum owing to acute splenic torsion in a child with immunoglobulin deficiency.

    wandering spleen is an uncommon clinical entity, which rarely affects children and adolescents. It is usually described in adults, being most common in the multiparous women of childbearing age. A case of a 14-year-old girl with a past history of splenomegaly and immunoglobulin a (IgA) deficiency, who presented with a sudden onset of abdominal pain, is presented. diagnosis of hemoperitoneum secondary to torsion of a wandering spleen was made by computed tomography scan and Doppler ultrasound. laparoscopy revealed hemoperitoneum owing to a ruptured and infarcted spleen. laparotomy was undertaken and open splenectomy was successfully performed. The patient was discharged after an uneventful postoperative course that was not punctuated by any major complication. Management of this rare surgical emergency is discussed. Based on the details of this case, the authors hypothesize that iga deficiency causes splenomegaly, which in turn predisposes to ligamentous laxity and splenic torsion. ( info)

8/8. Pediatric wandering spleen successfully treated by laparoscopic splenopexy.

    wandering spleen is a rare clinical condition associated with a high incidence of splenic torsion and infarction. The preferred treatment is splenopexy to reposition the spleen in the left upper quadrant of the abdomen. We report the case of a 12-year-old girl who presented with intermittent abdominal pain. An abdominal sonography was diagnostic of wandering spleen. The patient was successfully treated by laparoscopic splenopexy. The spleen was repositioned in the left upper quadrant and fixed to the posterior abdominal wall by a mesh patch attached by staples. To reinforce the splenopexy we created an additional support by plicating the phrenocolic ligament and suturing it to the lateral abdominal wall, making a pouch for the inferior pole of the spleen. The postoperative course was rapid and uneventful. A normal spleen position was verified by radionuclide scans at 3 days and 6 months postoperatively. Laparoscopic splenopexy is an excellent option for organ-preserving treatment in wandering spleen. ( info)

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