Wandering Spleen Causing Intestinal Obstruction after Repair of Congenital Diaphragmatic Hernia

Introduction

Wandering spleen is defined as a spleen located in an area other than the left upper quadrant. Abnormal laxity or an absence of supporting ligaments of the spleen result in an abnormally mobile spleen with a long vascular pedicle [2] [18]. Common clinical presentations include asymptomatic mass and acute or chronic abdominal pain due to torsion of the pedicle. There have been only 11 reports on an association of wandering spleen and intestinal obstruction in the English literature after 1900 [2] [3] [4] [5] [6] [9] [11] [12] [15] [19] [20]. We describe a case of small intestinal obstruction due to wandering spleen after repair of a congenital diaphragmatic hernia (CDH).

References

• 1 Bohrer JV. Torsion of wandering spleen.  Am Surg. 1940;  3 416-419
• 2 Brown CV, Virgilio GR, Vazquez WD. Wandering spleen and its complications in children: a case series and review of the literature.  J Pediatr Surg. 2003;  38 1676-1679
• 3 Calik A, Bilgin Y, Kucuktulu U. et al . Intestinal obstruction caused by splenic volvulus: report of a case.  Surg Today. 1996;  26 704-706
• 4 Clifford WJ, Ilano A. Accessory wandering spleen causing intestinal obstruction in pregnancy. A case report.  J Int Coll Surg. 1965;  43 26-28
• 5 Garcia JA, Garcia-Fernandez M, Romance A. et al . Wandering spleen and gastric volvulus.  Pediatr Radiol. 1994;  24 535-536
• 6 Githaiga JW, Adwok JA. Wandering spleen presenting as a right hypochondrial mass and intestinal obstruction.  East Afr Med J. 2002;  79 450-452
• 7 Greig JD, Sweet EM, Drainer IK. Splenic torsion in a wandering spleen, presenting as an acute abdominal mass.  J Pediatr Surg. 1994;  29 571-572
• 8 Hosgor M, Karaca I, Karkiner A. et al . Associated malformations in delayed presentation of congenital diaphragmatic hernia.  J Pediatr Surg. 2004;  39 1073-1076
• 9 Keidar S, Freud M, Rosenschein S. et al . Intestinal obstruction due to a wandering spleen.  Am J Gastroenterol. 1978;  69 701-704
• 10 Kleiner O, Newman N, Cohen Z. Pediatric wandering spleen successfully treated by laparoscopic splenopexy.  J Laparoendosc Adv Surg Tech A. 2006;  16 328-330
• 11 Moorthy K, Deshpande A, Rao P. et al . Wandering spleen causing splenic flexure volvulus and obstruction.  Indian J Gastroenterol. 1998;  17 67-68
• 12 Ng T, Lessin MS, Luks FI. et al . Wandering spleen presenting as duodenal obstruction after repair of congenital diaphragmatic hernia.  J Pediatr Surg. 1997;  32 1790-1792
• 13 Pandey SK, Bhattacharya S, Mishra RN. et al . Anatomical variations of the splenic artery and its clinical implications.  Clin Anat. 2004;  17 497-502
• 14 Pelizzo G, Lembo MA, Franchella A. et al . Gastric volvulus associated with congenital diaphragmatic hernia, wandering spleen, and intrathoracic left kidney: CT findings.  Abdom Imaging. 2001;  26 306-308
• 15 Salvin AA. Ectopic spleen causing intestinal obstruction.  Ann Surg. 1930;  92 263-269
• 16 Schaarschmidt K, Lempe M, Kolberg-Schwerdt A. et al . The technique of laparoscopic retroperitoneal splenopexy for symptomatic wandering spleen in childhood.  J Pediatr Surg. 2005;  40 575-577
• 17 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;  37 261-269
• 18 Steinberg R, Karmazyn B, Dlugy E. et al . Clinical presentation of wandering spleen.  J Pediatr Surg. 2002;  37 E30
• 19 Ugolini G, Potenti FM, Pricolo VE. Gastric outlet obstruction secondary to wandering spleen.  Surgery. 2000;  128 480-481
• 20 Van Dorp J. Bowel obstructon due to torsion of the spleen.  N Engl J Med. 1980;  303 1002

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