Torsion of wandering spleen: radiological findings
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PICTORIAL ESSAY
Torsion of wandering spleen: radiological findings Mariano José Parada Blázquez 1 Blanca Vargas Serrano 1
&
Daniel Rodríguez Vargas 2 & Manuel García Ferrer 1 & José Tinoco González 3 &
Received: 2 April 2020 / Accepted: 4 May 2020 # American Society of Emergency Radiology 2020
Abstract Wandering spleen (or ectopic spleen) is a rare anomaly resulting from hyperlaxity or even absence of the ligaments that hold the spleen in its anatomical position. Although more frequently a congenital condition, it can also be acquired. Torsion of the vascular pedicle is its potential main complication with subsequent development of splenic infarct. In this paper we will describe the pathogenesis, clinical manifestations, treatment options and radiological findings which allow the diagnosis of this entity. Keywords Wandering spleen . Torsion . Vascular pedicle . CT
Introduction The spleen is an intraperitoneal organ located in the left upper quadrant (LUQ) of the abdomen fixed in that position by three peritoneal ligaments: gastrosplenic, splenorenal and splenocolic, which are virtually always present, while the splenoomental and splenophrenic ligaments are more variable [1]. These ligaments originate from the dorsal mesogastrium, which will also give rise to the greater omentum [2]. Wandering spleen is a rare entity in which the spleen is not located in its usual position or orientation [3]. In most cases, the condition is a consequence of congenital anomalies in the development of the dorsal mesogastrium that induce absence or hyperlaxity of the peritoneal ligaments. Absence of these ligaments is associated with an abnormally long vascular pedicle, which predisposes to splenic ectopia and even malrotation of an orthotopic spleen. Some acquired conditions such as abdominal muscle laxity due to the hormonal effects of pregnancy, postsurgical changes and excessive laxity of the
* Mariano José Parada Blázquez [email protected] 1
Servicio de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
2
Servicio de Radiodiagnóstico, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
3
Servicio de Cirugía, Hospital Universitario Virgen del Rocío, Sevilla, Spain
anterior abdominal wall in Prune Belly syndrome have occasionally been associated with wandering spleen [4].
Torsion of wandering spleen Wandering spleen is most frequently diagnosed in male children younger than 1 year of age and in women during the third decade of life [5–7]. Patients often complain of dull or acute abdominal pain associated to a lower abdominal mass although it can also be incidentally detected in asymptomatic patients [8, 9]. Vascular compromise results from a long vascular pedicle that favours rotation of the spleen around its own axis [1]. The degree of splenic torsion can vary from mild (90°) to severe (2160°) [10]. Patients who suffer from incomplete mild torsion often complain of chronic abdominal pain related to splenic congestion, some patients may have pancitopenia secondary to hypersplenism [9]
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