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CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2022; 05(03): 202-208
DOI: 10.1055/s-0042-1749672
Case Report

Torsion of a Wandering Spleen Involving the Pancreatic Tail and Splenic Flexure and Isolated Left-Sided Portal Hypertension due to Chronic Splenic Vein Thrombosis

Manohar Kachare
1   Department of Radiodiagnosis, Government Medical College Miraj, Miraj, Maharashtra, India
,
Pooja Jaisinghani 
1   Department of Radiodiagnosis, Government Medical College Miraj, Miraj, Maharashtra, India
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Abstract

Wandering spleen is a rare entity, wherein the spleen is attached only by an elongated vascular pedicle, predisposing it to complications like hilar torsion, infarction, rupture, etc. Pancreatic volvulus is another very rare anomaly, with isolated case reports described in association with wandering spleen. The presentation varies from asymptomatic lump (stimulating a mass) to acute abdomen (due to torsion). We present a case of 26-year-old female patient who complained of pain in abdomen, and was radiologically diagnosed and surgically confirmed to have a torsion of wandering spleen with involvement of pancreatic tail and splenic flexure. Few cases with associated finding of gastric volvulus and sigmoid volvulus have been described previously. Involvement of descending colon in a 9-year-old child has been reported. However, to the authors' knowledge, this is the first case report describing the combination of wandering spleen with splenic flexure and pancreatic tail involvement in an adult.

Keywords

wandering spleen - torsion - volvulus - CT - ultrasound


Publikationsverlauf

Artikel online veröffentlicht:
11. Juli 2022

© 2022. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Alghamdi R, Alzahrnai A, Alosaimi A, Albabtain I. Infarcted wandering spleen: a case report from Saudi Arabia. J Surg Case Rep 2021; 2021 (06) b277
    CrossrefPubMedGoogle Scholar
  • 2 Blouhos K, Boulas KA, Salpigktidis I, Barettas N, Hatzigeorgiadis A. Ectopic spleen: an easily identifiable but commonly undiagnosed entity until manifestation of complications. Int J Surg Case Rep 2014; 5 (08) 451-454
    CrossrefPubMedGoogle Scholar
  • 3 Raissaki M, Prassopoulos P, Daskalogiannaki M, Magkanas E, Gourtsoyiannis N. Acute abdomen due to torsion of wandering spleen: CT diagnosis. Eur Radiol 1998; 8 (08) 1409-1412
    CrossrefPubMedGoogle Scholar
  • 4 Gorsi U, Bhatia A, Gupta R, Bharathi S, Khandelwal N. Pancreatic volvulus with wandering spleen and gastric volvulus: an unusual triad for acute abdomen in a surgical emergency. Saudi J Gastroenterol 2014; 20 (03) 195-198
    CrossrefPubMedGoogle Scholar
  • 5 Masroor M, Sarwari MA. Torsion of the wandering spleen as an abdominal emergency: a case report. BMC Surg 2021; 21 (01) 289
    CrossrefPubMedGoogle Scholar
  • 6 Ganarin A, Fascetti Leon F, La Pergola E, Gamba P. Surgical approach of wandering spleen in infants and children: a systematic review. J Laparoendosc Adv Surg Tech A 2021; 31 (04) 468-477
    CrossrefPubMedGoogle Scholar
  • 7 Thompson RJ, Taylor MA, McKie LD, Diamond T. Sinistral portal hypertension. Ulster Med J 2006; 75 (03) 175-177
    PubMedGoogle Scholar
  • 8 Jha AK, Bhagwat S, Dayal VM, Suchismita A. Torsion of spleen and portal hypertension: pathophysiology and clinical implications. World J Hepatol 2021; 13 (07) 774-780
    CrossrefPubMedGoogle Scholar
  • 9 Seif Amir Hosseini A, Streit U, Uhlig J. et al. Splenic torsion with involvement of pancreas and descending colon in a 9-year-old boy. BJR Case Rep 2018; 5 (01) 20180051
    PubMedGoogle Scholar
  • 10 Flores-Ríos E, Méndez-Díaz C, Rodríguez-García E, Pérez-Ramos T. Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon. J Radiol Case Rep 2015; 9 (10) 18-25
    CrossrefPubMedGoogle Scholar
  • 11 Cohen MS, Soper NJ, Underwood RA, Quasebarth M, Brunt LM. Laparoscopic splenopexy for wandering (pelvic) spleen. Surg Laparosc Endosc 1998; 8 (04) 286-290
    CrossrefPubMedGoogle Scholar
  • 12 Buzelé R, Barbier L, Sauvanet A, Fantin B. Medical complications following splenectomy. J Visc Surg 2016; 153 (04) 277-286
    CrossrefPubMedGoogle Scholar
  • 13 Sheflin JR, Lee CM, Kretchmar KA. Torsion of wandering spleen and distal pancreas. AJR Am J Roentgenol 1984; 142 (01) 100-101
    CrossrefPubMedGoogle Scholar
  • 14 Parker LA, Mittelstaedt CA, Mauro MA, Mandell VS, Jaques PF. Torsion of a wandering spleen: CT appearance. J Comput Assist Tomogr 1984; 8 (06) 1201-1204
    CrossrefPubMedGoogle Scholar
  • 15 Moll S, Igelhart JD, Ortel TL. Thrombocytopenia in association with a wandering spleen. Am J Hematol 1996; 53 (04) 259-263
    CrossrefPubMedGoogle Scholar
  • 16 Ugolini G, Potenti FM, Pricolo VE. Gastric outlet obstruction secondary to wandering spleen. Surgery 2000; 128 (03) 480-481
    CrossrefPubMedGoogle Scholar
  • 17 Karaosmanoglu AD, Onur MR, Karcaaltıncaba M. Wandering spleen with volvulus of pancreas. J Med Ultrason (2001) 2015; 42 (03) 413-416
    CrossrefPubMedGoogle Scholar
  • 18 Gilman RS, Thomas RL. Wandering spleen presenting as acute pancreatitis in pregnancy. Obstet Gynecol 2003; 101 (5 Pt 2): 1100-1102
    PubMedGoogle Scholar
  • 19 Lacreuse I, Moog R, Kauffmann I, Méfat L, Bailey C, Becmeur F. Laparoscopic splenopexy for a wandering spleen in a child. J Laparoendosc Adv Surg Tech A 2007; 17 (02) 255-257
    CrossrefPubMedGoogle Scholar
  • 20 Feroci F, Miranda E, Moraldi L, Moretti R. The torsion of a wandering pelvic spleen: a case report. Cases J 2008; 1 (01) 149
    CrossrefPubMedGoogle Scholar
  • 21 Magno S, Nanni L, Retrosi G, Cina A, Gamba PG. An unusual case of acute pancreatitis and gastric outlet obstruction associated with wandering spleen treated by laparoscopic splenopexy. J Laparoendosc Adv Surg Tech A 2011; 21 (05) 467-470
    CrossrefPubMedGoogle Scholar
  • 22 Torri F, Parolini F, Vanzetti E, Milianti S, Cheli M, Alberti D. Urgent laparoscopic mesh splenopexy for torsion of wandering spleen and distal pancreas: a case report. Asian J Endosc Surg 2015; 8 (03) 350-353
    CrossrefPubMedGoogle Scholar
  • 23 Aswani Y, Anandpara KM, Hira P. Wandering spleen with torsion causing pancreatic volvulus and associated intrathoracic gastric volvulus. An unusual triad and cause of acute abdominal pain. JOP 2015; 16 (01) 78-80
    Google Scholar
  • 24 Ahmadi H, Tehrani MM. A rare case of splenic torsion with sigmoid volvulus in a 14-year-old girl. Acta Med Iran 2016; 54 (01) 72-75
    PubMedGoogle Scholar
  • 25 Taydas O, Ogul H, Bayraktutan U, Kantarci M. A multicystic, malrotated pancreas in a patient with wandering spleen. Gastroenterology 2018; 155 (01) e16-e17
    CrossrefPubMedGoogle Scholar
  • 26 Colombo F, D'Amore P, Crespi M, Sampietro G, Foschi D. Torsion of wandering spleen involving the pancreatic tail. Ann Med Surg (Lond) 2019; 50: 10-13
    CrossrefPubMedGoogle Scholar
  • 27 Ng MRA, McCullers M, Gamenthaler A. Wandering spleen with 720-degree torsion treated with splenectomy and distal pancreatectomy. Am Surg 2019; 85 (08) e430-e432
    CrossrefPubMedGoogle Scholar
  • 28 Asafu Adjaye Frimpong G, Aboagye E, Ayisi-Boateng NK. et al. Concurrent occurrence of a wandering spleen, organoaxial gastric volvulus, pancreatic volvulus, and cholestasis - a rare cause of an acute abdomen. Radiol Case Rep 2019; 14 (08) 946-951
    CrossrefPubMedGoogle Scholar
  • 29 Saldívar-Martínez DE, Galindo-Sánchez HM, Fonseca-Sada I, Marcos-Ramírez ER, Vázquez-Fernández F. Infarcted wandering spleen and pancreatic volvulus in a patient with concomitant Grynfelt-Lesshaft haernia. Cir Cir 2021; 89 (S1): 20-22
    PubMedGoogle Scholar
  • 30 Shen MR, Barrett M, Waits S, Williams AM. Wandering spleen leading to splenic torsion with gastric and pancreatic volvulus. BMJ Case Rep 2021; 14 (01) e235918
    CrossrefPubMedGoogle Scholar