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PubMed2004

Laparoscopic management of the wandering spleen.

Wandering spleen is a rare clinical condition associated with a high incidence of splenic torsion and infarction. The preferred treatment for this condition is splenopexy to reposition the spleen in the left upper quadrant of the abdomen and to preserve splenic function. We present two cases of wandering spleen managed by laparoscopic splenopexy. Both young women presented with intermittent abdominal pain. A CT scan was diagnostic of wandering spleen in each case. Both patients were successfully treated with the laparoscopic splenopexy. The spleen was inserted in a Vicryl mesh bag and fixed in the left upper quadrant in both cases. Both patients had resolution of their preoperative symptoms. Laparoscopic splenopexy has many advantages over open splenopexy or splenectomy, including preserving splenic function, minimal postoperative pain, early discharge from the hospital, and rapid recovery.

Abdominal Pain↗
PubMed1998

Laparoscopic splenopexy for wandering (pelvic) spleen.

Wandering spleen is a rare clinical diagnosis with a high incidence of splenic torsion and infarction. The preferred treatment for this condition currently is splenopexy to reposition and fixate the spleen in the left upper quadrant of the abdomen to preserve splenic function. We recently performed the first splenopexy for a wandering spleen using laparoscopic techniques. The patient was a 19-year-old woman who had an asymptomatic lower abdominal/pelvic mass found on physical examination. Diagnostic evaluation (ultrasound, computed tomography scan, and liver-spleen scan) showed an absent spleen in the upper abdomen, normal uterus and ovaries, and an 11 x 7-cm pelvic spleen. Laparoscopic splenopexy was performed using Vicryl mesh to suspend and fixate the spleen in the left upper quadrant of the abdomen. Total operative time was 175 min, there were no intra- or postoperative complications, and the patient was discharged on the 1st postoperative day. Follow-up at 2 and 7 months indicated that she was asymptomatic with a nonpalpable spleen. The results suggest that a laparoscopic approach to splenopexy should be considered for the treatment of patients with a wandering spleen.

Adult↗
PubMed1997

Wandering spleen in childhood: a report of three cases.

Wandering spleen is a rare cause of abdominal pain in children, and an accurate diagnosis is seldom made preoperatively. A splenectomy is the treatment of choice in cases of splenic torsion and infarction, while in patients with chronic symptoms splenopexy may also be attempted. We herein report three patients with wandering spleen, of whom two presented with acute torsion of the splenic pedicle and one demonstrated an asymptomatic mobile abdominal mass. In the first case splenopexy was attempted, but during follow-up the spleen was found to have undergone atrophy. The presentation, diagnostic procedures, and treatment modalities in pediatric wandering spleen are reviewed.

Child↗
PubMed1978

Selective transcatheter embolization of the upper gastrointestinal tract: an experimental study.

Transcatheter gastric embolization using Ivalon shavings was performed on three groups of dogs. The left gastric artery and splenic branches (the short gastric and left gastroepiploic arteries) were embolized in Group I, the left gastric artery in Group II, and the splenic branches in Group III. Infarctions of the gastric mucosa occurred only in Group I. Ischemic ulcers developed in three of the five dogs in Group I and in one of the three dogs in Group II. The study suggest that embolization can only be performed safety if particles of 0.3 mm or larger are used.

Animals↗
PubMedDate not supplied

Splenic calcifications in heterozygote sickle cell patients.

A small, fibrotic, and even calcified spleen is the hallmark of homozygote sickle cell disease in adults. Such a condition is very rare in sickle-thalassemia and, to our knowledge, not previously reported in a sickle cell trait. We report two heterozygote sickle cell siblings with splenic calcifications, one sickle cell trait and one sickle-beta+-thalassemia, without any history suggestive of splenic vasooclusive-infarctive crisis.

Adult↗
PubMedDate not supplied

Perisplenitis as a cause of acute abdomen: a case report.

Splenitis can complicate blood-borne sepsis in hemodialysis patients. Symptoms include left upper quadrant pain and tenderness in addition to generalized systemic manifestation of infection. Clinical diagnosis is difficult and there is no specific investigation to confirm it. Computed tomography scan of the spleen can help in identifying a splenic abscess, rupture, or infarction. A splenectomy is the treatment of choice in splenic abscess, in splenitis to avoid spontaneous rupture, and in recurrent perisplenitis.

Abdomen, Acute↗
PubMedDate not supplied

A pattern-oriented approach to splenic imaging in infants and children.

The spleen in infants and children is commonly involved in a variety of pathologic processes. Some of these processes cause isolated splenic disease, whereas others involve the spleen as part of a systemic illness. To facilitate differential diagnosis of splenic abnormalities, a pattern-oriented approach to the imaging evaluation of the pediatric spleen was developed. With this approach, splenic anomalies are categorized as anomalies of splenic shape (clefts, notches, lobules), location (eg, wandering spleen), number (polysplenia, asplenia), or size (splenomegaly, splenic atrophy); solitary lesions (eg, cysts, lymphangiomas, hemangiomas, hamartomas); multiple focal lesions (eg, trauma, infection and inflammation, neoplasms, storage disorders); and diffuse disease without focal lesions (eg, infarction, heavy metal deposition, hemangioendotheliomas, peliosis). A variety of imaging modalities can be used in splenic assessment, including computed tomography, magnetic resonance imaging, ultrasound, and technetium-99m scintigraphy. The imaging appearance of the pediatric spleen depends on the patient's age and the modality used; however, familiarity with the spectrum of radiologic patterns of splenic involvement will facilitate correct diagnosis and prompt treatment.

Adolescent↗
PubMedDate not supplied

Embolization of the spleen for treatment of splenomegaly and hypersplenism in patients with portal hypertension.

Splenectomy in cases of hypersplenism involves significant risk of serious complications, including infection, hemorrhage, portal systemic thrombosis, and necrosis of the stomach or small bowel. Alternative procedures such as transcatheter embolization have been associated with a high frequency of splenic or subphrenic abscess, preventing clinical use. We used partial splenic embolization under careful antibiotic protection to successfully treat thrombocytopenia in 18 patients, most of whom had hypersplenism and splenomegaly secondary to portal hypertension. Of the 30 embolizations performed, the only serious complications encountered were abscess in two patients (who had almost total infarction) and four cases of splenic vein thrombosis. We investigated the possible effect of splenic embolization on portal venous pressure in three patients and found no pressure change.

Abscess↗
PubMed1989

Left ventricular thrombus and systemic emboli complicating the cardiomyopathy of Duchenne's muscular dystrophy.

A 17-year-old boy with Duchenne's muscular dystrophy and congestive cardiomyopathy with a left ventricular thrombus is described. The patient presented with flank pain, and computed tomography of the abdomen revealed multiple bilateral renal infarcts. An echocardiogram delineated a left ventricular thrombus and generalized hypokinesis with a left ventricular ejection fraction of 25%. Heparin therapy was started, but the patient died of refractory congestive heart failure. Autopsy revealed diffuse skeletal myopathy consistent with Duchenne's muscular dystrophy as well as biventricular cardiomyopathy with a recent left ventricular apical-septal mural thrombus. Right atrial thrombus, a left upper lobe pulmonary embolus, and splenic and renal infarcts were also noted. To our knowledge, this is the first reported case of left ventricular thrombus with or without systemic emboli in the cardiomyopathy of Duchenne's muscular dystrophy.

Adolescent↗
PubMed2006

The wandering spleen: CT findings and possible pitfalls in diagnosis.

AIM: To report the CT features of wandering spleen, a rare condition which can be incidentally detected as an abdominal or pelvic mass or can present with torsion, causing an acute abdomen. MATERIALS AND METHODS: The CT studies of seven patients, two children and five adults, with wandering spleen were reviewed. CT was performed urgently in three patients for acute abdomen, and electively in four. RESULTS: CT findings of wandering spleen included absence of the spleen in its normal position and a mass located elsewhere in the abdomen or pelvis, i.e. an ectopic spleen, enhancing homogeneously in four cases and failing partially or completely to enhance in the other three, indicating infarction. A "whirl" appearance representing the twisted splenic pedicle was seen in the three cases with torsion. Urgent splenectomy confirmed infarction secondary to torsion. CONCLUSION: The possible diagnosis of wandering spleen should be kept in mind when CT shows the spleen to be absent from its usual position and a mass is found elsewhere in the abdomen or pelvis. When, in addition, a "whirl" or partial or no enhancement of this mass are seen in a case presenting with acute abdomen, torsion of a wandering spleen is a likely diagnosis.

Abdomen, Acute↗
PubMed2001

Immunohistochemical detection of apolipoprotein B-100 and immunoglobulins (IgA, IgM, IgG) in the splenic arteries of aging dogs.

Accumulation of lipids and hyalinosis in the splenic arteries of aged dogs are frequently detected by routine histopathologic examinations. The purpose of this study was to pinpoint the localization of canine apolipoprotein B-100 (CApoB-100) and immunoglobulins (IgA, IgM, IgG) in the splenic arteries of aging dogs (n = 80) through the use of immunohistochemical techniques. CApoB-100 deposits were found in the subendothelial space, extracellular matrix, and atheromatous lesions in the tunica media of the arteries in dogs > or = 6 years of age. Foamy cytoplasm of the infiltrated macrophages was also CApoB-100 immunopositive. In dogs > or = 10 years of age, almost all central arteries were CApoB-100 immunopositive. Hyaline deposits within the wall were characterized by immunopositivity against canine IgA, IgM, IgG, and albumin. Lipid accumulation in splenic arteries may be an age-related lesion and a precursor of the atheromatous plaques associated with splenic hemorrhage and infarcts later in life. In addition, deposition of immunoglobulins, probably mediated by immune complexes, may play an important role in the development of canine vascular diseases similar to human disease.

Age Factors↗
PubMed1977

Therapeutic embolization with long-term occluding agents and their effects on embolized tissues.

The effects of long-term occlusion of branches of the celiac and renal arteries were studied in 13 pigs, using isobutyl 2-cyanoacrylate (ibc), the Gianturco-Anderson-Wallace wool coil, and lvalon. IBC permanently occluded 2- to 8-cm lengths of both vessels, including their branches so that collateral circulation was not able to preserve the tissue supplied by the occluded artery. Gastric ulcers, splenic and hepatic infarcts, and large, sterile biliary cysts were observed on postmortem examination. Permanent occlusion was also observed with the wool coil and lvalon, but the pathological results were much less deleterious. The authors conclude that IBC is presently unsafe for use in branches of the celiac artery.

Angiography↗
PubMed1998

Laparoscopic splenopexy for pediatric wandering spleen.

Wandering spleen is an uncommon condition, showing a splenic hypermobility that results from laxity or maldevelopment of its suspensory ligament. This condition results in constant danger of splenic torsion and infarction. Wandering spleen was diagnosed in a 2-year-old girl who complained of intermittent abdominal pain, and viability of the spleen was confirmed by doppler ultrasound scan. Elective laparoscopic splenopexy was performed by anchoring the spleen wrapped in absorbable mesh. To our knowledge, this is the first reported case of laparoscopic splenopexy for wandering spleen. The authors believe that this approach is a safe and effective procedure for wandering spleen with the advantage of minimally invasive surgery.

Child, Preschool↗
PubMedDate not supplied

[Splenic cysts and tumors: diagnosis and management].

Cysts and tumors of the spleen are rare and are often discovered fortuitously. They are most often asymptomatic but may present with abdominal pain in the left upper quadrant. Splenic cysts are far more common than solid lesions; true cysts must be differentiated from pseudocysts of the pancreas and from cystic degeneration following splenic contusion or infarction. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). Diagnosis can usually be established with the clinical context and imagery (ultrasound, CT, MRI). Surgery should be avoided for angiomas and pseudocysts. Spleen-conserving surgery is indicated for large symptomatic epidermoid cysts. Splenectomy is often required for hydatid cysts and tumors. Of the solid tumors, hemangiomas and lymphangiomas often have a characteristic fleshy appearance. For other solid tumors, whether benign or malignant, imaging may give some clues to the diagnosis, but diagnostic certitude often requires pathologic examination of the piece. Needle biopsy is contraindicated because of the risk of bleeding. Resection should be as limited as possible in order to avoid the risks of total splenectomy (overwhelming sepsis, thrombosis).

Biopsy↗
PubMed1996

Intrasplenic masses of "preserved" functioning splenic tissue in sickle cell disease: correlation of imaging findings (CT, ultrasound, MRI, and nuclear scintigraphy).

PURPOSE: We studied six patients with sickle cell disease (SSD), five homozygous for sickle cell anemia and one with sickle beta-thalassemia, in whom rounded intrasplenic masses proved to be preserved functioning splenic tissue. MATERIALS AND METHODS: Available images including computed tomography, ultrasonography, bone scans (Tc-99m MDP), liver spleen scans (Tc-99m sulfur colloid), and MRI were evaluated. RESULTS: The masses were low density on CT (in an otherwise calcified spleen), hypoechoic relative to the echogenic spleen on US, and had the imaging characteristics of normal spleen on MRI. They failed to accumulate Tc-99m MDP but did demonstrate uptake of Tc-99m sulfur colloid. CONCLUSION: In a patient with SSD and intrasplenic masses, proper correlation of multiple imaging modalities will establish the diagnosis of functioning splenic tissue and avoid mistaken diagnosis of splenic abscess or infarction.

Adolescent↗
PubMed1992

Splenic embolization prior to myelosuppressive treatment in hepatocarcinoma and active chronic hepatitis.

In the treatment of active chronic hepatitis and hepatocellular carcinoma some effective drugs can produce myelosuppression. Hypersplenism may considerably limit the dosage of such drugs. Splenectomy is an effective treatment for hypersplenism, although it is not without complications. Partial splenic embolization is a good and safe procedure; 15 patients were treated in order to achieve higher platelet and leukocyte counts. Embolization has been performed with gelfoam with local and systemic antibiotics (Spigos' protocol) and 50-75% of the splenic parenchyma was infarcted. All patients could be treated for the underlying hepatopathy with adequate dosages of interferon or chemotherapeutic drugs.

Aged↗