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OJHAS Vol. 7, Issue 4: (2008
Oct-Dec) |
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Wandering spleen:
A common presentation of an uncommon anomaly |
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Ugwu AC
Department of medical
Radiography and Radiological Sciences, Faculty of Health Sciences and
Technology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria
Ogbonna CO,
Radiology Department, Federal Medical Centre, P.M.B 102, Abakaliki, Ebonyi
State, Nigeria
Imo AO
Radiology Department, Ebonyi State University Teaching Hospital, Abakaliki, Ebonyi
State, Nigeria |
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Address For Correspondence |
Department of medical
Radiography and Radiological Sciences,
Faculty of Health Sciences and
Technology,
Nnamdi Azikiwe University,
Nnewi Campus, Anambra State, Nigeria
E-mail:
tonybullng@yahoo.ca |
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Ugwu AC, Ogbonna CO, Imo AO. Wandering spleen: A common presentation of an uncommon anomaly Online J Health Allied Scs.
2008;7(4):9 |
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Submitted: Sep 16,
2008; Accepted: Jan 19, 2009 Published: Feb 25, 2009 |
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| Abstract: |
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Background:
With the advent of real time ultrasonography of the abdomen, the spleen
is no longer an inaccessible organ. Wandering spleen is a rare entity
with only less than 500 cases reported so far. Method:
This case report presents a 16-year- old Nigerian girl admitted
in a medical centre but referred for ultrasonography on account of a
clinical history of lower abdominal tenderness. Result:
Ultrasonography examination revealed that the spleen was not found in
its normal anatomical position. However, a well defined acoustic
signature of the spleen was seen in the pelvis. Conclusion:
Ultrasonography which is far cheaper than magnetic resonance imaging
(MRI) and computed tomography (CT) is a valuable diagnostic aid in this
condition.
Key Words:
Wandering spleen, ultrasonography, Nigeria |
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The spleen develops from the mesoderm in the dorsal mesogastrium. It
lies in the left hypochondrium behind the stomach, and is about 12cm
long and 7cm broad.1 The spleen is fixed in position by the
lieno-renal and gastro – splenic ligaments; the phrenico- colic ligament
provides additional support. The ligaments are embryological condensations
that take place in the peritoneum and congenital peritoneal anomalies
may result in splenic displacement.
Wandering spleen is a rare clinical occurrence with fewer than five
hundred cases reported in literature. The incidence based on several
large series of splenectomies is less than 0.5%.2 The spleen
can be found anywhere in the abdomen or pelvis owing to
its long vascular pedicle. The usual treatment is fixation of the spleen
(splenopexy) except in case of infarction where there is no evidence
of blood flow to the spleen after detortion, splenectomy should be considered.3
We present a
rare case of wandering (pelvic) spleen showing a normal acoustic signature.
A 16 year old Nigerian girl of Ibo origin presented to the gynecological
clinic, with a one week history of anorexia and lower abdominal tenderness.
After a clinical examination, provisional diagnoses of appendicitis
and pelvic inflammatory disease (PID) were made.
Haematological and biochemical investigations were normal. Ultrasonography
was performed with a 3.5 MHz linear transducer. The spleen was not visualized
in its normal position (Fig 1). However, a well defined, homogenous
mass with vascular channels (Fig 2) was seen in the pelvic region, anterior
to the uterus and a little bias to the left adnexa. A diagnosis of a
normal sized wandering (pelvic) spleen was made.
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Fig 1: Ultrasound
scan of the left upper quadrant of the abdomen showing the right kidney
and water in the stomach. The spleen is absent in the splenic bed
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Fig 2. A dual B-
mode (ultrasound) display of the abdomen and pelvis showing the spleen,
uterus and urine in urinary bladder |
Wandering or ectopic spleen has two possible etiologies: congenital
and acquired. Congenital form occurs due to failure of development of
dorsal mesogastrium when the lesser sac is formed. The acquired form
occurs mostly in multiparous females as the ligaments which
are holding the spleen in its position become lax.3
Synonyms of wandering the spleen include: displaced spleen, drifting
spleen, floating spleen, splenic ptosis, splenoptosis, systopic spleen
and pelvic spleen. A review of the English literature from 1960 to 1992
by Dawson and Roberts, documented 148 cases which included both pediatric
and adult cases.4
Wandering spleen is commonly seen in females in the second decade of
life (the patient under review is a female in her second decade of life
-16 years). The clinical presentation of a wandering spleen is variable;
patients may be asymptomatic or they may have acute abdominal crises
or chronic vague lower abdominal pain.3 The most common presentation
in children is an acute surgical abdomen occurring due to infarction
from torsion of the splenic pedicle. 5, 6
The clinical diagnosis of wandering spleen may be quite difficult and
the haematological and biochemical investigations may be non – specific.
Non – invasive imaging procedures such as ultrasonography, scintigraphy,
computed tomography (CT) and magnetic resonance imaging (MRI) are usually
diagnostic. However, ultrasonography is still being considered to be
the most reliable for diagnosis of wandering spleen.7 The
non – invasiveness of ultrasonography makes it an acceptable modality,
especially in children. Doppler sonography helps in the evaluation of
organ blood flow.8 In the absence of infarction, thrombosis
and hypersplenism, in patients presenting with an acute abdomen, detorsion
and splenopexy is a recognized surgical option.9
In summary, we present a rare occurrence of pelvic spleen on ultrasonography.
Awareness of this rare anomaly and the diagnostic utility of ultrasonography
may be helpful for guiding both doctors and imaging scientists in the
assessment of patients with similar clinical and songraphic presentations.
- Singh I. Essentials of anatomy.
New Delhi: Jaypee Brothers Medical Publishers Ltd. 2002, P 283.
- Kinori I, Rifkin MD. A truly
wandering spleen. J ultrasound Med. 1988;7:101-5.
- Alawi MH, Khalifa A, Bana
H. wandering spleen: A Challenging diagnosis. Pak J Med Sci 2005;21(4):482–4.
- Dawson JH, Roberts NG. Management
of the wandering spleen. Aust NZJ Surg 1994;64;441–4.
- Buchner M, Baker MS. The
wandering spleen. Surg Gynecol obstet 1992;175:373 – 87.
- Abel I. wandering spleen
with torsion of the pedicle. Ann Surg 1933;98:722–5
- Tait NP, Young IR. The wandering
spleen: an ultrasonic diagnosis. J Clin ultrasound 1985;13:45–6.
- Nakamura T, Moriyasu F,
Ban N et al Quantitative Measurement of abdominal arterial flow using
image directed Doppler ultrasonography: superior mesenteric, splenic,
and common hepatic arterial blood flow in normal adults. J Clin ultrasound
1989;17:261–8.
- Hirose R, Kitano S, Bando
T, Ueda Y, Sato K, Yoshida T, Suenobu S, Kawano T, Izumi T Laparascopic
Splenopexy for Paediatric wandering spleen. J paediatric Surg 1998;33:1571–3.
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