Rare case of wandering spleen in patient with abdominal pain reported
Portugal: Splenic torsion is a rare but important differential diagnosis in patients presenting with acute abdomen, reveals a recent study in the International Journal of Surgery Case Reports. So, the diagnosis should be made quickly before the development of life-threatening complications. Surgery becomes essential in such cases and splenopexy or splenectomy can be performed.
Wandering spleen is an unusual condition characterized by the hypermobile spleen. It is rare and is more common in children below 1 year of age and in the third decade of life. In the second peak, it is more frequent in females. Clinical manifestation can include asymptomatic to an abdominal emergency. It is treated often through surgery.
Charlène Marques Viana, Department of General Surgery, de Braga Hospital, Braga, Portugal, and colleagues present a case report of splenic torsion and a review of cases described in literature.
The case in question is of a 40 years old woman presenting with complaints of abdominal pain associated with nausea and vomiting. A marked tenderness and a palpable abdominal mass on left hypochondrium were found as well as a slight increase in inflammatory parameters.
A CT was performed and demonstrated findings compatible with splenic torsion. Surgery was performed doing laparoscopic splenectomy; a review of literature was made using the keyword combination: "wandering spleen". The research resulted in 451 articles.
Key findings include:
- The physical examination and CT are fundamental for diagnosis. Surgery was performed and laparoscopic splenectomy was made because infarcted spleen;
- About the review of literature, the majority of patients were female and the average age at the time of the diagnosis was 25.2 years.
- 69.5% needed splenectomy and 78.6% of surgeries were laparotomic.
- The best method of confirming the diagnosis is by a CT scan, however, Doppler US imaging is an equally helpful modality.
- Detorsion and splenopexy can be done when the spleen is viable. When there is infarction spleen, splenectomy is necessary.
"Splenic torsion is a rare but important differential diagnosis in patients presenting with acute abdomen. Diagnosis should be made promptly before the development of life-threatening complications. Surgery is often necessary and splenopexy or splenectomy can be done.," concluded the authors.
The study, "Splenic torsion, a challenging diagnosis: Case report and review of literature," was published in the International Journal of Surgery Case Reports.
DOI: https://doi.org/10.1016/j.ijscr.2018.02.032
