Share this Article
Ho CL
Correspondence: Dr Ho Chi Long, clho_2002@yahoo.com
ABSTRACT
Wandering spleen or splenoptosis is an uncommon entity and often an asymptomatic finding of acute abdomen in the emergency department. A high index of suspicion for splenic torsion is required, particularly in patients with known splenomegaly, as this condition could potentially lead to splenic infarction. Recognition of this condition can help avoid potential confusion with acute abdomen of other aetiologies. Herein, we present a unique case of wandering spleen with chronic torsion, which, to the best of our knowledge, has never been described in an elderly patient with haemoglobin H thalassaemia. We also review the literature for the aetiology and pathogenesis of wandering spleen, and discuss the relevant diagnostic modalities and treatment options.
Keywords: splenomegaly, splenoptosis, thalassaemia, torsion
Singapore Med J 2014; 55(12): e198-e200; http://dx.doi.org/10.11622/smedj.2014185
REFERENCES
| 1. Lane TM, South LM. Management of a wandering spleen. J R Soc Med 1999; 92:84-5. PMid:10450220 PMCid:PMC1297068 | ||||
| 2. Qazi SA, Mirza SM, Muhammad AM, Al Arrawi MH, Al-Suhaibani YA. Wandering spleen. Saudi J Gastroenterol 2004; 10:1-7. PMid:19861821 | ||||
| 3. Liu HT, Lau KK. Wandering spleen: an unusual association with gastric volvulus. AJR Am J Roentgenol 2007; 188:W328-30. http://dx.doi.org/10.2214/AJR.05.0672 | ||||
| 4. Spector JM, Chappell J. Gastric volvulus associated with wandering spleen in a child. J Pediatr Surg 2000; 35:641-2. http://dx.doi.org/10.1053/jpsu.2000.0350641 | ||||
| 5. Romero J, Barksdale EM Jr. Wandering spleen: a rare cause of abdominal pain. Pediatr Emerg Care 2003; 19:412-4. http://dx.doi.org/10.1097/01.pec.0000101582.65509.cc | ||||
| 6. Zimmermann ME, Cohen RC. Wandering spleen presenting as an asymptomatic mass. Aust N Z J Surg 2000; 70:904-6. http://dx.doi.org/10.1046/j.1440-1622.2000.02008.x | ||||
| 7. Horwitz JR, Black CT. Traumatic rupture of a wandering spleen in a child: case report and literature review. J Trauma 1996; 41:348-50. http://dx.doi.org/10.1097/00005373-199608000-00027 | ||||
| 8. Paterson A, Frush DP, Donnelly LF, et al. A pattern-oriented approach to splenic imaging in infants and children. Radiographics 1999; 19:1465-85. http://dx.doi.org/10.1148/radiographics.19.6.g99no231465 | ||||
| 9. Taori K, Ghonge N, Prakash A. Wandering spleen with torsion of vascular pedicle: early diagnosis with multiplanar reformation technique of multislice spiral CT. Abdom Imaging 2004; 29:479-81. http://dx.doi.org/10.1007/s00261-003-0142-7 | ||||
| 10. Magowska A. Wandering spleen: a medical enigma, its natural history and rationalization. World J Surg 2013; 37:545-50. http://dx.doi.org/10.1007/s00268-012-1880-x | ||||
| 11. Weatherall DJ. Genetic variation and susceptibility to infection: the red cell and malaria. Br J Haematol 2008; 141:276-86. http://dx.doi.org/10.1111/j.1365-2141.2008.07085.x | ||||
| 12. McFee RB, Musacchio T, Gorgescu D, et al. Wandering spleen with torsion in a geriatric patient. Report of an unusual case with a brief review of the clinical picture and management. Dig Dis Sci 1995; 40:2656-9. http://dx.doi.org/10.1007/BF02220456 | ||||
| 13. Dawson JH, Roberts NG. Management of the wandering spleen. Aust N Z J Surg 1994; 64:441-4. http://dx.doi.org/10.1111/j.1445-2197.1994.tb02249.x | ||||
| 14. Nemcek AA Jr, Miller FH, Fitzgerald SW. Acute torsion of a wandering spleen: diagnosis by CT and duplex Doppler and color-flow sonography. AJR Am J Roentgenol 1991; 157:307-9. http://dx.doi.org/10.2214/ajr.157.2.1853811 | ||||
| 15. Ityel H, Granot Y, Vaknine H, Judich A, Shimonov M. Splenic torsion of a wandering spleen. Isr Med Assoc J 2011; 13:119-20. PMid:21443043 | ||||
| 16. Ben Ely A, Zissin R, Coppel L, et al. The wandering spleen: CT findings and possible pitfalls in diagnosis. Clin Radiol 2006; 61:954-58. http://dx.doi.org/10.1016/j.crad.2006.06.007 | ||||
| 17. Collie DA, Ferguson JM, Allan PL, Redhead DN. Case report: computed tomography features of complete splenic infarction, cavitation and spontaneous decompression complicating pancreatitis. Br J Radiol 1995; 68:662-4. http://dx.doi.org/10.1259/0007-1285-68-810-662 | ||||
| 18. Rodkey ML, Macknin ML. Pediatric wandering spleen: case report and review of literature. Clin Pediatr 1992; 31:289-94. http://dx.doi.org/10.1177/000992289203100505 | ||||
| 19. 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; 26:306-8. http://dx.doi.org/10.1007/s002610000171 | ||||
| 20. Corcione F, Caiazzo P, Cuccurullo D, et al. Laparoscopic splenectomy for the treatment of wandering spleen. Surg Endosc 2004; 18:554-6. http://dx.doi.org/10.1007/s00464-003-4254-5 | ||||