Case report: Laparoscopic splenopexy without use of mesh

Geoffrey Fasen, MD, Carlos Puig, MD, Michael Kendrick, MD, David Nagorney, MD. Mayo Clinic- Rochester

Objective: Case report describing a novel technique in an adult patient for the performance of laparoscopic splenopexy to treat wandering spleen.

Patient Background: A 27 year old woman with amedical history significant for omphalocele presented initially for evaluation of chronic abdominal pain. She had been experiencing worsening pain over the past 3 years requiring pain medication for adequate analgesia. Her abdominal discomfort was unaccompanied by any nausea, vomiting, or obstipation suggestive of bowel obstruction. She did have chronic constipation requiring multiple laxitive use to maintain reasonable bowel habits. Due to concern for malrotation, MRI enterography was obtained, demonstrating malrotation of the bowel as well as a wandering spleen located in the pelvis with evidence of torsion and freely mobile pancreatic body and tail. Secondary to her young age and increased infectious risk with the patient’s chosen occupation, the patient preferred a splenic preserving approach over a straightforward splenectomy.

Surgical Technique: The patient was taken for a laparoscopic splenopexy. The proximal descending colon was mobilized medially from the abdominal wall. Using electrocautery and blunt dissection, a pre-peritoneal pocket was created in the left upper abdomen. The spleen was de-torsed and inserted into the pocket. The peritoneum was then closed with a combination of surgical clips and running suture over the spleen ensuring retention of the spleen in the preperitoneal pocket. To reduce risk of internal herniation, the inferior border of the pancreas was then sutured to the retroperitoneum obliterating any potential defect posterior to the pancreas.

Preliminary Outcome: Follow up CT imaging obtained 1 month post operatively demonstrated the spleen in the retroperitoneal position without evidence of torsion or slippage. Postoperative exam was notable for resolution of her chronic abdominal pain with no analgesic requirement, as well as improved constipation.

Conclusion: Wandering spleen is a rare entity which has been described only as case reports and small case series in the literature. The majority of splenopexy reports derive from the pediatric literature with few having been described in an adult population. Those that have been published in both populations typically describe the formation of a mesh bag around the spleen which is then fixed into the left upper quadrant. In this case we describe a more elegant, simpler method for splenic fixation that in short term follow up appears to be successful. The natural laxity of the peritoneum as well as mobilization of the descending colon allow for the spleen to be placed in a near anatomic position in the retroperitoneum while reducing the risk of internal hernia formation or adhesive disease due to intraperitoneal mesh.

« Return to SAGES 2015 abstract archive