PDF(Pubmed)
Abstract：
BACKGROUND: Wandering spleen is a rare clinical entity in which the spleen is hypermobile and migrate from its normal left hypochondriac position to any other abdominal or pelvic position as a result of absent or abnormal laxity of the suspensory ligaments (Puranik in Gastroenterol Rep 5:241, 2015, Evangelos in Am J Case Rep. 21, 2020) which in turn is due to either congenital laxity or precipitated by trauma, pregnancy, or connective tissue disorder (Puranik in Gastroenterol Rep 5:241, 2015, Jawad in Cureus 15, 2023). It may be asymptomatic and accidentally discovered for imaging done for other reasons or cause symptoms as a result of torsion of its pedicle and infarction or compression on adjacent viscera on its new position. It needs to be surgically treated upon discovery either by splenopexy or splectomy based on whether the spleen is mobile or not.
METHODS: We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful.
CONCLUSIONS: Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.
METHODS: We present a case of 39 years old female Ethiopian patient who presented to us complaining constant lower abdominal pain especially on the right side associated with swelling of one year which got worse over the preceding few months of her presentation to our facility. She is primiparous with delivery by C/section and a known case of HIV infection on HAART. Physical examination revealed a right lower quadrant well defined, fairly mobile and slightly tender swelling. Hematologic investigations are unremarkable. Imaging with abdominopelvic U/S and CT-scan showed a predominantly cystic, hypo attenuating right sided pelvic mass with narrow elongated attachment to pancreatic tail and absent spleen in its normal position. CT also showed multiple different sized purely cystic lesions all over both kidneys and the pancreas compatible with AD polycystic kidney and pancreatic disease. With a diagnosis of wandering possibly infarcted spleen, she underwent laparotomy, the finding being a fully infarcted spleen located on the right half of the upper pelvis with twisted pedicle and dense adhesions to the adjacent distal ileum and colon. Release of adhesions and splenectomy was done. Her post-operative course was uneventful.
CONCLUSIONS: Wandering spleen is a rare clinical condition that needs to be included in the list of differential diagnosis in patients presenting with lower abdominal and pelvic masses. As we have learnt from our case, a high index of suspicion is required to detect it early and intervene by doing splenopexy and thereby avoiding splenectomy and its related complications.
摘要：
背景：脾脏游荡是一种罕见的临床实体，由于悬吊韧带的缺失或异常松弛，脾脏过度移动并从其正常的左下软骨位置迁移到任何其他腹部或骨盆位置（Puranik在GastroenterolRep5：241，2015，Evangelos21，2020)，这反过来是由于先天性松弛或外伤导致的，怀孕,或结缔组织疾病（Puranik在胃肠病报告5：241，2015，Jawad在Cureus15，2023）。它可能是无症状的，并且由于其他原因进行成像而意外发现，或者由于椎弓根扭转和梗塞或在其新位置上对相邻内脏的压迫而引起症状。根据脾脏是否活动，需要通过脾切除术或脾切除术进行手术治疗。
方法：我们介绍了一例39岁的埃塞俄比亚女性患者，患者主诉持续的下腹部疼痛，尤其是右侧伴有1年肿胀，在患者就诊后的前几个月里，疼痛加重。她是初产妇，剖腹产，已知一例HAART感染HIV。体格检查显示右下象限明确，相当移动和轻微的嫩肿胀。血液学检查不显著。腹肾盂U/S成像和CT扫描显示主要是囊性，轻度减弱右侧骨盆肿块，狭窄的细长附着于胰尾，正常位置缺少脾脏。CT还显示，肾脏和胰腺上有多个不同大小的纯囊性病变，与AD多囊肾和胰腺疾病相符。诊断为脾脏游荡可能梗塞，她做了剖腹手术,该发现是位于上骨盆右半部分的完全梗塞的脾脏，椎弓根扭曲，并与相邻的远端回肠和结肠紧密粘连。进行粘连释放和脾切除术。她的术后过程很顺利。
结论：脾脏游走是一种罕见的临床疾病，需要纳入下腹部和盆腔肿块患者的鉴别诊断清单。正如我们从案件中学到的，需要高度怀疑才能及早发现并通过脾切除术进行干预，从而避免脾切除术及其相关并发症。
方法：我们介绍了一例39岁的埃塞俄比亚女性患者，患者主诉持续的下腹部疼痛，尤其是右侧伴有1年肿胀，在患者就诊后的前几个月里，疼痛加重。她是初产妇，剖腹产，已知一例HAART感染HIV。体格检查显示右下象限明确，相当移动和轻微的嫩肿胀。血液学检查不显著。腹肾盂U/S成像和CT扫描显示主要是囊性，轻度减弱右侧骨盆肿块，狭窄的细长附着于胰尾，正常位置缺少脾脏。CT还显示，肾脏和胰腺上有多个不同大小的纯囊性病变，与AD多囊肾和胰腺疾病相符。诊断为脾脏游荡可能梗塞，她做了剖腹手术,该发现是位于上骨盆右半部分的完全梗塞的脾脏，椎弓根扭曲，并与相邻的远端回肠和结肠紧密粘连。进行粘连释放和脾切除术。她的术后过程很顺利。
结论：脾脏游走是一种罕见的临床疾病，需要纳入下腹部和盆腔肿块患者的鉴别诊断清单。正如我们从案件中学到的，需要高度怀疑才能及早发现并通过脾切除术进行干预，从而避免脾切除术及其相关并发症。
