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29 August 2022 : Case report  Italy

[In Press] Laparoscopic Splenectomy of a Wandering Pelvic Splenomegaly in a Young Woman Treated in Childhood with Surgery for Diaphragmatic Hernia and Adhesiolysis for Intestinal Obstruction

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease, Congenital defects / diseases

Eleonora Cartesegna1AE, Pier Carlo Rassu1AE, Valerio Accarpio1F, Stefano Barbieri1B, Maria Maurizia Bocchio1D, Eliana Giaminardi1D, Antonino Malfitano1C, Alessandro Montobbio1F, Sonja Olcese1D, Denise Palombo1B, Francesca RĂ© ORCID logo1D, Carmine Gianfranco Di Somma1G

DOI: 10.12659/AJCR.936964

Am J Case Rep In Press; DOI: 10.12659/AJCR.936964  

Available online: 2022-08-29, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Wandering spleen (WS) is a rare medical condition in which the spleen migrates from its usual position commonly to the pelvis or lower abdomen assuming an ever-wandering state. The incidence of ectopic spleen is 0.2%, with variable clinical manifestations from asymptomatic to abdominal emergency. Symptoms are most attributed to complications related to torsion, so that a nonoperative management of a WS is not advised. According to the literature, 69.5% of patients with WS need splenectomy and 78.6% need laparotomy.
The patient exhibited vague intermittent lower abdominal pain for 6 months due to progressive torsion of the spleen, which resulted in venous congestion. Abdominal investigation revealed a mobile intra-abdominal mass and parenchymatous consistency in the pelvis. Diagnosis by computed tomography outlined abdominal splenomegaly with abnormal position both of pancreas and stomach. Laparoscopy established a giant spleen, with a lengthened pelvic and twisty vascular pedicle. In its ectopic location, the spleen had dragged the pancreas with it, which had taken a vertical position. The classic splenic ligaments were not recognizable. Spleen was removed with median laparotomic incision. Splenectomy was performed to prevent any traumatic fractures of the spleen, a complete twist of the splenic hilum, and the onset of recurrent acute pancreatitis.
Wandering spleen is rare in patients presenting with acute abdominal pain. An approach supported by clinical findings and investigation, even considering splenectomy over splenopexy, and laparoscopy over open surgery, may solve and prevent complications and health risks.

Keywords: Laparoscopy; Splenectomy; Wandering Spleen


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Am J Case Rep In Press; DOI: 10.12659/AJCR.937581  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923