Wandering spleen causing small bowel obstruction: Laparoscopic surgical treatment (with video)

Niccolò Petrucciani; Sara Claudia Barone; Leonida Mucaj; Francesco D'Angelo; Paolo Aurello; Gianfranco Silecchia

doi:10.1016/j.ijscr.2023.108961

Wandering spleen causing small bowel obstruction: Laparoscopic surgical treatment (with video)

Int J Surg Case Rep. 2023 Nov:112:108961. doi: 10.1016/j.ijscr.2023.108961. Epub 2023 Oct 13.

Authors

Niccolò Petrucciani¹, Sara Claudia Barone², Leonida Mucaj², Francesco D'Angelo², Paolo Aurello², Gianfranco Silecchia²

Affiliations

¹ Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy. Electronic address: niccolo.petrucciani@uniroma1.it.
² Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.

Abstract

Introduction: Wandering spleen (WS) is a clinical entity in which the spleen is not located in its normal anatomical site. Few cases have been reported, mainly in women of childbearing age. This condition can be congenital or acquired due to excessive elasticity of the spleen's suspensory ligaments. WS may cause acute complications requiring emergency surgery, especially related to the rotation of its vascular pedicle, leading to chronic or acute ischemia. The aim of the present case is to show a rare complication of WS, small bowel obstruction (SBO), and its management.

Presentation of case: We report the case of a 40-year-old female presenting with abdominal pain, nausea, and vomiting. CT scan showed SBO caused by WS located in the pelvis with an enlarged spleen vascular pedicle (SVP). Laparoscopic exploration, splenectomy, small bowel resection and anastomosis were performed.

Discussion: WS may cause chronic or acute complications, mainly linked with enlargement and torsion of SVP, including acute ischemia and spleen necrosis, or compression of the near organs such as small intestine, stomach, pancreas. The diagnosis is based on physical examination, CT scan and blood exams. Generally, the WS's treatment is laparoscopic splenectomy or splenopexy. In case of vital spleen, splenopexy can be performed, in case of not vital spleen, splenectomy should be preferred.

Conclusion: This case provides an excellent example of SBO related to WS. In the video, the management of this complex situation is shown. In these cases, splenectomy represents a valuable option.

Keywords: Laparoscopic; Small bowel obstruction; Spleen; Splenectomy; Splenomegaly.

Publication types

Case Reports