Hand Assisted Laparoscopy for Wandering Spleen

This is a case presentation of a patient with a wandering spleen. The patient is an 18 year old female who suffered from a malarial infection at age five. A CT scan at that time documented her spleen was located in the normal anatomical position. When the patient was 18 years old, she underwent an ultrasound to rule out the possibility of polycystic ovaries. At that time, it was discovered that her spleen was in her pelvis. A CT scan was performed showing the spleen located in the right lower quadrant (RLQ). The patient was offered a laparoscopic splenopexy to return the spleen to its correct anatomical position. This allows the patient to retain her spleen and avoid the complications associated with splenectomy, such as Overwhelming Post Splenectomy Infection (OPSI).
At time of laparoscopy, the presence of the spleen in the RLQ was confirmed. Using three 5mm ports and a hand port, the spleen was mobilized to the left upper quadrant (LUQ). The wandering spleen was secured in the left subdiaphragmatic location by the use of a vicryl mesh bag that was fashioned out of a single large vicryl mesh. An omental sling was also used to further support the spleen. A one year follow up confirms that the spleen is still located in the correct anatomical position.
This is a unique case in that the patient was known to have a normally located spleen at a young age and then found to have a wandering spleen later in life. The wandering spleen in this patient is most likely secondary to her malarial infection which caused hypersplenism leading to attenuation of the suspensory ligaments and eventual migration into the RLQ. A wandering spleen is a rare condition, with an unknown incidence. A recent literature search shows only case reports, without any documentation of incidence or prevalence of wandering spleens. Most cases are due to congenital or acquired absence of anchoring ligaments. The risk of performing a splenectomy on this patient is OPSI. The incidence of OPSI is documented at 0.13 to 8.1% with a mortality of 30 to 60%. This makes the option of splenopexy very attractive and the use of minimally invasive techniques avoid large painful incisions.

Session: Podium Video Presentation

Program Number: V040

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