- Wandering spleen
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At the time the article was created Elena Trajcevska had no recorded disclosures.
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- Floating spleen
- Splenic ptosis
- Ectopic spleen
- Splenoptosis
- Drifting spleen
- Systopic Spleen
- Displaced spleen
Wandering spleen is a rare condition in which the spleen migrates from its usual anatomical position, commonly to the lower abdomen or pelvis.
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Epidemiology, clinical presentation, radiographic features, treatment and prognosis.
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- Cases and figures
Wandering spleen is rare, with a reported incidence of <0.5%.
Diagnosis is most commonly made between the ages of 20-40 years and is more common in multiparous women 1,6 .
A wandering spleen can be an elusive diagnosis as its presentation is greatly variable and intermittent torsion can cause non-specific signs and symptoms.
It can present as an asymptomatic or painful abdominal mass, intermittent abdominal pain, or as an acute abdomen (e.g. bowel obstruction , acute pancreatitis ) 3,4,6 .
The abnormal mobility of the spleen is caused by an abnormality of its suspensory ligaments. There may be a congenital absence or underdevelopment of these ligaments, or an acquired laxity of the ligaments caused by various conditions, such as pregnancy or diseases causing splenomegaly . Due to these abnormal ligaments, a long vascular pedicle may form, containing the splenic vessels, predisposing the spleen to torsion and consequently splenic infarction 4 .
There are various causes, mostly related to splenomegaly .
- sickle cell disease
- heterotaxy syndrome
- lymphoproliferative disease
- mononucleosis
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The often non-specific clinical presentation of a wandering spleen makes radiological evaluation invaluable in its diagnosis. Performing the radiological investigations in different positions allows identification of the wandering spleen’s inclination to wander.
Plain radiograph
A wandering spleen is not frequently diagnosed on plain film radiography, but findings on abdominal x-ray may include 3,6 :
- absence of splenic shadow in the left upper quadrant
- space-occupying soft tissue mass in an abnormal location
- distended bowel loops
Can be used to identify an abnormal anatomical position of the spleen, usually low-lying, or an absence of the spleen in the left upper quadrant 3,5 . It has been described that the mobility of the spleen can be demonstrated when scanning in the right decubitus position, with the migration of the spleen to the dependent position on the right side 6 . There may also be a finding of a characteristic comma-shaped spleen in an extra-anatomical position 4 .
Doppler ultrasound
Doppler ultrasound can demonstrate the vascular flow to the spleen and help diagnose splenic torsion or infarction 6 .
CT with contrast can be useful in identifying the displaced spleen and demonstrating the degree of organ ischemia in the setting of torsion and infarction of the spleen 1 .
Possible findings include 4,5,7 :
- absence of the spleen in the left upper quadrant
- ovoid or comma-shaped abdominal mass
- whirl sign : a whirled appearance of hyperdense, non-enhancing splenic vessels
- enlarged spleen, with minimal or no enhancement
- signs of splenic hypoperfusion: heterogeneous, capsular (rim-like) or globally decreased enhancement
Nuclear medicine
Technetium sulfur colloid liver-spleen scan can be used to identify an abnormal abdominal mass as the spleen 1 .
A wandering spleen is treated surgically, ideally by detorsion and splenopexy. However, if there is evidence of hypersplenism , thrombosis , or infarction , splenectomy may be necessary. Laparoscopic techniques for both splenopexy and splenectomy are preferred, as they offer the benefits of minimally invasive surgery 2-4 .
- 1. Wallace S, Herer E, Kiraly J, Valikangas E, Rahmani R. A Wandering Spleen: Unusual Cause of a Pelvic Mass. Obstet Gynecol. 2008;112(2 Pt 2):478-80. doi:10.1097/AOG.0b013e3181809671 - Pubmed
- 2. Magowska A. Wandering Spleen: A Medical Enigma, Its Natural History and Rationalization. World J Surg. 2013;37(3):545-50. doi:10.1007/s00268-012-1880-x - Pubmed
- 3. Lebron R, Self M, Mangram A, Dunn E. Wandering Spleen Presenting as Recurrent Pancreatitis. JSLS. 2008;12(3):310-3. PMC3015861 - Pubmed
- 4. Bouassida M, Sassi S, Chtourou M et al. A Wandering Spleen Presenting as a Hypogastric Mass: Case Report. Pan Afr Med J. 2012;11:31. PMC3325069 - Pubmed
- 5. Raissaki M, Prassopoulos P, Daskalogiannaki M, Magkanas E, Gourtsoyiannis N. Acute Abdomen Due to Torsion of Wandering Spleen: CT Diagnosis. Eur Radiol. 1998;8(8):1409-12. doi:10.1007/s003300050562 - Pubmed
- 6. Taori K, Sanyal R, Deshmukh A, Saini T. Pseudocyst Formation: A Rare Complication of Wandering Spleen. Br J Radiol. 2005;78(935):1050-2. doi:10.1259/bjr/33073529 - Pubmed
- 7. Lam Y, Yuen K, Chong L. Acute Torsion of a Wandering Spleen. Hong Kong Med J. 2012;18(2):160-2. - Pubmed
- 8. Yildiz A, Ariyurek M, Karcaaltincaba M. Splenic Anomalies of Shape, Size, and Location: Pictorial Essay. The Scientific World Journal. 2013;2013:1-9. doi:10.1155/2013/321810 - Pubmed
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Wandering Spleen
Wandering spleen can be found on imaging studies as a spleen that is located somewhere other than it’s usual position in the left upper abdomen. This article will discuss diagnosis, complications and treatment of wandering spleen.
What is Wandering Spleen?
A wandering spleen, also known as a floating spleen or splenoptosis, is a condition where the spleen migrates from its usual position in the upper left abdomen. The spleen is a crucial organ involved in filtering blood and fighting infections.
In individuals with a wandering spleen, the ligaments that hold the spleen in place are either elongated or weakened, allowing it to move freely within the abdomen. This mobility can lead to various health issues, including abdominal pain, bloating, and in severe cases, spleen torsion or infarction, where the blood supply to the spleen is cut off, leading to tissue death.
Symptoms of Wandering Spleen
The symptoms of a wandering spleen can vary widely from person to person. Some individuals may not experience any symptoms at all, while others may have noticeable signs. Common symptoms include:
– **Abdominal pain or discomfort:** Often reported in the lower abdomen and may vary in intensity. – **A palpable mass:** Some patients may feel a movable lump in their abdomen. – **Gastrointestinal symptoms:** Such as bloating, constipation, or indigestion.
In cases where the spleen becomes twisted (torsion), symptoms can quickly escalate to sharp abdominal pain, vomiting, and fever, necessitating immediate medical attention.
Causes and Risk Factors
The exact cause of a wandering spleen is not always clear, but it is often related to the weakening or malformation of the ligaments that secure the spleen. This condition can be congenital (present at birth) or acquired due to injury, pregnancy, or previous abdominal surgeries. Factors that may increase the risk of developing a wandering spleen include:
– **Ligamentous laxity:** Natural or acquired looseness of the ligaments. – **Trauma:** Abdominal injuries that may damage spleen ligaments. – **Pregnancy and childbirth:** Hormonal changes and physical strain can weaken abdominal structures.
Diagnosis of Wandering Spleen
Diagnosing a wandering spleen involves a combination of physical examinations, medical history, and imaging tests. Physicians may initially suspect the condition based on symptoms and a physical exam. Diagnostic imaging, such as ultrasound, CT scans, or MRI, plays a crucial role in confirming the diagnosis by visually locating the spleen’s position and assessing its condition.
Treatment Options
The treatment for a wandering spleen depends on the severity of the symptoms and the overall health of the patient. Options include:
– **Observation:** In asymptomatic cases, regular monitoring may be recommended. – **Surgical intervention:** For symptomatic patients, surgery is often necessary. The two main surgical options are: – **Splenopexy:** Reattaching the spleen to its correct position using synthetic materials or tissue. – **Splenectomy:** Removal of the spleen, typically reserved for cases where the spleen is damaged or has become necrotic.
Post-Treatment Care and Considerations
After treatment for a wandering spleen, patients will need to follow up with their healthcare provider for regular check-ups. If the spleen was removed, vaccinations against certain bacteria may be recommended since the spleen plays a critical role in fighting infections. Patients who undergo splenopexy should avoid activities that may risk abdominal trauma to prevent recurrence.
A wandering spleen is a rare condition that can lead to significant health issues if not properly addressed. Understanding the symptoms, causes, and available treatment options is important for anyone diagnosed with this condition. With timely and appropriate medical care, individuals with a wandering spleen can lead healthy and active lives. Always consult with a healthcare provider for an accurate diagnosis and personalized treatment plan tailored to your specific needs.
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Clinical presentation. A wandering spleen can be an elusive diagnosis as its presentation is greatly variable and intermittent torsion can cause non-specific signs and symptoms. It can present as an asymptomatic or painful abdominal mass, intermittent abdominal pain, or as an acute abdomen (e.g. bowel obstruction, acute pancreatitis) 3,4,6.
A wandering spleen, also known as a floating spleen or splenoptosis, is a condition where the spleen migrates from its usual position in the upper left abdomen. The spleen is a crucial organ involved in filtering blood and fighting infections. In individuals with a wandering spleen, the ligaments that hold the spleen in place are either ...
liver, followed by the spleen and kidneys (38). [...] foie, suivies de la rate et des reins (38). Many translated example sentences containing "spleen" – French-English dictionary and search engine for French translations.