Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 98
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
CLINICAL IMAGE
Year : 2013  |  Volume : 3  |  Issue : 2  |  Page : 57-58

A case of wandering spleen


1 Lal Bahadur Shastri Hospital, New Delhi, India
2 Department of Neurosurgery, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India
3 Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India

Date of Submission01-Jul-2013
Date of Acceptance29-Oct-2014
Date of Web Publication11-Jul-2014

Correspondence Address:
Suryapratap Singh
Department of Neurosurgery, Narayana Medical College & Hospital, Nellore, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-7095.136501

Rights and Permissions
  Abstract 

Wandering spleen is a rare entity characterized by huge spleen with laxity of the splenic ligaments, absence of peritoneal attachments and presence of long pedicles. We herein present a case of a 42-year-old female with wandering spleen that presented to our clinic with intermittent abdominal pain associated with an abdominal lump.

Keywords: Acute abdomen, splenectomy, splenopexy, splenoptosis, systopic spleen


How to cite this article:
Sahu S, Singh S, Sharma K, Kalakoti P. A case of wandering spleen. Int J Stud Res 2013;3:57-8

How to cite this URL:
Sahu S, Singh S, Sharma K, Kalakoti P. A case of wandering spleen. Int J Stud Res [serial online] 2013 [cited 2019 Jul 24];3:57-8. Available from: http://www.ijsronline.net/text.asp?2013/3/2/57/136501

A 42-year-old woman presented to our clinic with 4 months history of an abdominal lump and vague discomfort, intermittent abdominal pain with fullness of abdomen. She reported the pain to have increased in frequency since last 2 weeks. She had a normal body built, was afebrile and with stable vitals. Abdominal examination elicited diffuse tenderness and an intra-abdominal lump spanning over the epigastrium, umbilical, hypogastrium, left hypochondrium, left lumbar, left iliac, and the right iliac region [Figure 1]a]. Routine hemogram, liver and kidney functions, serum electrolytes, urine microscopy, and chest roentgenogram were all normal. Ultrasound of the abdomen demonstrated massive splenic enlargement extending from the epigastrium to hypogastrium on the left to the iliac region on the right. Patient was hospitalized, and initial conservative treatment was initiated. Following 4 h of admission, her abdominal pain became severe and made her restless. A decision on performing an emergency exploratory laparotomy was undertaken in view of her condition following high-risk consent. Intra-operatively, a massive, mobile spleen measuring 25 × 14 × 6.5 cm and with long pedicle and long ligaments was localized extending from the left upper abdomen to the left pelvic region [Figure 1]b]. A splenectomy was performed [Figure 1]c], and the massive organ weighed 3750 g [Figure 1]d]. Histopathological study of the specimen revealed normal splenic tissue. Postoperatively, patient received broad spectrum antibiotics and supportive care. To prevent overwhelming postsplenectomy sepsis, patient was vaccinated with polyvalent pneumococcal vaccine, quadrivalent meningococcal/diphtheria hemophilus b conjugate [1] . With the postoperative period being uneventful, patient was discharged on the 11 th day following surgery. Patient was followed-up once in every 3 months for a period of 1 year and is doing well with no clinical complications.

Wandering spleen, also known as ectopic, displaced, devious or aberrant spleen, is a rare entity defined as a huge, single spleen in an abdominal position rather than its anatomical site owing to laxity of its pedicles and absence of ligamentous attachments [2],[3] . Even though exact etiology is unknown, abdominal laxity, multiparity, irregular menses, hormonal effects of pregnancy, embryologic developmental errors are postulated to be possible causes for laxity of splenic ligaments [4] . While clinical presentation may pose dilemma to the surgeons as it could be mistaken with other abdominal lumps, ultrasonography, tomographic scans and scintigraphy are the most accurate diagnostic tests for wandering spleen [5] . In our case, a provisional diagnosis of splenomegaly was made prior to surgery, and the case was confirmed intra-operatively as a wandering spleen due to the presence of long, vascular splenic pedicle without any peritoneal attachments. It is critical to understand the complications related to wandering spleen specially those arising due to its length of the pedicle. The abnormally fixed spleen can twist on its vascular pedicle predisposing to ischemia that may progress to infarction if not promptly treated surgically [6] . Postoperative management including antibiotics, usually cephalosporins/penicillins and vaccinations to prevent life-threatening infections along with regular follow-ups are utmost essential for these patients.
Figure 1 (a) Intra-abdominal lump spanning over the epigastrium, umbilical, hypogastrium, left hypochondrium, left lumbar, left iliac, and the right iliac region. (b) Intra-operatively, a massive, mobile spleen measuring 25 × 14 × 6.5 cm and with long pedicle and long ligaments was localized extending from the left upper abdomen to the left pelvic region. (c) Splenectomy performed. (d) Massive spleen weighing 3750 g

Click here to view


 
  References Top

1.Atkinson WL, Pickering LK, Schwartz B, et. al. General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP). MMWR Recomm Rep 2002;51(RR-2):1-35.  Back to cited text no. 1
    
2.Desai DC, Hebra A, Davidoff AM, Schnaufer L. Wandering spleen: A challenging diagnosis. South Med J 1997;90(4):439-43.  Back to cited text no. 2
    
3.Papakyriacou K, Nicolaou N, Symeonides P. Wandering spleen: A rare emergency condition. Br J Surg 1996;83(1):50.  Back to cited text no. 3
    
4.Soleimani M, Mehrabi A, Kashfi A, et. al. Surgical treatment of patients with wandering spleen: report of six cases with a review of the literature. Surg Today 2007;37(3):261-9.  Back to cited text no. 4
    
5.Dawson JH, Roberts NG. Management of the wandering spleen. Aust N Z J Surg 1994;64(6):441-4.  Back to cited text no. 5
    
6.Schmidt SP, Andrews HG, White JJ. The splenic snood: an improved approach for the management of the wandering spleen. J Pediatr Surg 1992;27(8):1043-4.  Back to cited text no. 6
    


    Figures

  [Figure 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
References
Article Figures

 Article Access Statistics
    Viewed2092    
    Printed142    
    Emailed0    
    PDF Downloaded186    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]