Single-Incision Laparoscopic Splenectomy and Splenic Autotransplantation for an Enlarged Wandering Spleen with Torsion

Abstract

A wandering spleen is a rare condition in which the spleen is not located in the left upper quadrant, but instead is found in the lower abdomen or in the pelvic region because of the laxity of the peritoneal attachments. The unusually long pedicle is susceptible to twisting, which can lead to ischemia, and eventually to necrosis. We herein report a case of an enlarged wandering spleen with torsion, successfully treated by single-incision laparoscopic splenectomy and autotransplantation. The transplanted splenic tissues could be identified on a spleen scintigram obtained 3 months after the surgery. Howell-Jolly bodies were not observed in blood specimens. This procedure is able to prevent an overwhelming postsplenectomy infection, and leads to satisfactory cosmetic results.

Keywords

wandering spleen - single umbilical incision - autotransplantation

• References

• 1 Magowska A. Wandering spleen: a medical enigma, its natural history and rationalization. World J Surg 2013; 37 (3) 545-550
• 2 Soleimani M, Mehrabi A, Kashfi A, Fonouni H, Büchler MW, Kraus TW. Surgical treatment of patients with wandering spleen: report of six cases with a review of the literature. Surg Today 2007; 37 (3) 261-269
• 3 Steinberg R, Karmazyn B, Dlugy E , et al. Clinical presentation of wandering spleen. J Pediatr Surg 2002; 37 (10) E30
• 4 Fiquet-Francois C, Belouadah M, Ludot H , et al. Wandering spleen in children: multicenter retrospective study. J Pediatr Surg 2010; 45 (7) 1519-1524
• 5 Fukuzawa H, Urushihara N, Ogura K , et al. Laparoscopic splenopexy for wandering spleen: extraperitoneal pocket splenopexy. Pediatr Surg Int 2006; 22 (11) 931-934
• 6 Martínez-Ferro M, Elmo G, Laje P. Laparoscopic pocket splenopexy for wandering spleen: a case report. J Pediatr Surg 2005; 40 (5) 882-884
• 7 Schaarschmidt K, Lempe M, Kolberg-Schwerdt A, Schlesinger F, Hayek I, Jaeschke U. The technique of laparoscopic retroperitoneal splenopexy for symptomatic wandering spleen in childhood. J Pediatr Surg 2005; 40 (3) 575-577
• 8 Hirose R, Kitano S, Bando T , et al. Laparoscopic splenopexy for pediatric wandering spleen. J Pediatr Surg 1998; 33 (10) 1571-1573
• 9 Takayasu H, Ishimaru Y, Tahara K, Otani Y, Yamagishi J, Ikeda H. Splenic autotransplantation for a congested and enlarged wandering spleen with torsion: report of a case. Surg Today 2006; 36 (12) 1094-1097
• 10 Esposito C, Settimi A, Centonze A, Damiano R, Maglio P, Esposito G. Enlarged wandering spleen treated with hemisplenectomy and fixation of the residual spleen. Pediatr Surg Int 2005; 21 (6) 488-490
• 11 Bell R, Boswell T, Hui T, Su W. Single-incision laparoscopic splenectomy in children. J Pediatr Surg 2012; 47 (5) 898-903
• 12 Oyama K, Sasaki A, Chiba T, Nitta H, Otsuka K, Wakabayashi G. Single-incision laparoscopic splenectomy for idiopathic thrombocytopenic purpura: report of a case. Surg Today 2011; 41 (8) 1091-1094
• 13 Pisters PWT, Pachter HL. Autologous splenic transplantation for splenic trauma. Ann Surg 1994; 219 (3) 225-235
• 14 Iinuma H, Okinaga K, Sato S, Tomioka M, Matsumoto K. Optimal site and amount of splenic tissue for autotransplantation. J Surg Res 1992; 53 (2) 109-116
• 15 Ando K, Miyano T, Yamataka A , et al. Torsion of autotransplanted splenic tissue in Gaucher disease. J Pediatr Surg 1997; 32 (5) 747-749