Hamdy S Abd Alla, Mohamad H Abo-Raya, PhD, Sherief A Saber, MD, Ahmad A Alshoora, MD, Sherief M Algarf, MSc, Ossama H Elkhadrawy, PhD, Gamal I Moussa, PhD. Faculty of medicine, Tanta university Hospital
Introduction: Wandering spleen is a very rare condition. Patients may be asymptomatic or present with an abdominal mass. Occasionally, patients present with acute abdominal pain due to acute torsion of the splenic vascular pedicle. In the absence of a splenic pathology, splenopexy is recommended while with splenic infarction, segmental or total splenectomy should be performed. We report two cases of wondering spleen; one of them was complicated by acute torsion.
A 24-years old single female patient presented to the outpatient clinic with recurrent lower abdominal pain. Her past medical and surgical history was negative. Abdominal examination revealed a mass in the left iliac and hypo-gastric regions. Abdominal ultrasonography and contrast-enhanced CT scan of the abdomen confirmed that the spleen was found partly in the left iliac and hypo-gastric regions. Blood tests were normal. A decision of splenectomy to prevent splenic torsion was made. A small (7 cm) left middle paramedin incision was used. Pathologic examination of the resected spleen showed normal splenic tissue. The patient was discharged home 2 day after surgery. No complications were recorded over a 2-year postoperative follow-up.
A 56-year-old female patient presented to the emergency room with a 6-hours history of severe left upper quadrant abdominal pain associated with vomiting and fever. The patient's history was positive for compensated liver cirrhosis. On physical examination, blood pressure was 110/65 mm Hg, pulse rate 100 beats/min, respiratory rate 22 breaths/min and body temperature 38.6°C. Palpation of the abdomen showed a tender swelling partly in the left lumbar, umbilical and left iliac regions with mild abdominal guard. Laboratory investigations were within normal range except for: LDH 1190 u/l, Hb 8.9 gm/dl, platelet count 65000/ml, AST 84 U/L, ALT 120 U/L, serum albumin 2.7 gm/dl. Abdominal ultrasonography and contrast-enhanced abdominal CT scan confirmed the diagnosis of a wondering spleen (18.6 cm) complicated by acute splenic torsion with infarction of most splenic parenchyma. The spleen was removed through a left subcostal incision. Pathology of the spleen showed necrosis of splenic tissue. The patient developed mild ascites that was controlled rapidly with diuretics. She was discharged home 3 day after surgery. No more complications were recorded during 4-year postoperative follow up.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79170
Program Number: P169
Presentation Session: Poster (Non CME)
Presentation Type: Poster