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| Year : 1981 | Volume
: 27
| Issue : 1 | Page : 42-3 |
Wandering spleen.
Koppikar MG, Vaze AM, Bapat RD
How to cite this article:
Koppikar M G, Vaze A M, Bapat R D. Wandering spleen. J Postgrad Med 1981;27:42 |
Wandering spleen, also known as mobile spleen or ptosed spleen is a rare clinical condition.[1], [2], [8] An uncomplicated mobile spleen presents as a lump whose free mobility baffles clinician not aware of the condition. Its rarity and unusual mobility prompted us to report this case.
M.M., a 45 year old female patient was admitted with a lump and vague discomfort in abdomen, mainly in the left hypochondrium of 3 months' duration. There was no genitourinary and gastro-intestinal disturbance. Patient was menopausal and had 5 full term normal deliveries.
On examination, she was averagely built and nourished. There was no pallor, icterus or lymphadenopathy. Abdominal muscular tone was poor. There was an intra-abdominal lump in the left lumbar and umbilical region, 15 cms x 12 cms in size, non-tender and firm with smooth surface and moving with respiration and freely mobile in all directions. Ballotment was positive. Renal angle was normal. Rest of the abdomen and other systems were normal.
During observation in the ward the lump was found to be so mobile that it could occupy all different quadrants of abdomen including opposite hypochondrium, lumbar region, iliac fossa and pelvis. At times it slipped under the left hypochondrium and was not palpable.
Clinical diagnosis was not made though possibility of wandering fibroid (subserous fibroid) of uterus or ovarian tumour with a long pedicle was thought of.
Haemogram, urine, stool, blood biochemistry, plain X-ray chest and abdomen were normal. Barium meal follow through and excretory pyelogram were normal.
The patient was subjected to exploratory laparotomy. At exploration, the lump was found to be a mobile spleen with a long lienorenal ligament which provided long pedicle. The left kidney was normal. Rest of the viscera was normal. Splenectomy was done. The spleen was 15 cm x 12.5 cm x 9 cm. There was no notch on any border and did not have the usual impressions made by the neighbouring viscera. The weight was 330 gms. The histology was normal.
Wandering spleen is a rare clinical condition.[3],[4],[5] Not more than 150 cases have been reported. Maingot[6], [7] states that a few surgeons have operated. on ptosed spleen. Chamberlain[3] in his series of 100 splenectomies did not have ptosed spleen.
Adkins[2] states that normal spleen (functionally) which has become displaced from its normal location in the left hypochondrium and acquired a wander thirst to varying locations in the abdominal cavity presents an interesting subject to exact causative factor, and a real problem for accurate diagnosis. When it presents as an uncomplicated case, the range and ready free mobility in the desired direction baffles a clinician not aware of the condition. Only 4 cases were diagnosed in Abell's[1] series of 97 cases.
Other presentations reported are as torsion and splenic vein thrombosis.[1], [2], [8]
Hall[4] states that during development of the stomach, when the dorsal wall rotates to the left, it carries the greater omentum in which the spleen develops. If the attachment between the spleen and stomach are deficient the spleen gradually increases in range of mobility.[8] Contributory factors are enlargement of spleen, visceroptosis, and poor abdominal tone commonly seen in multipara. The condition is common in females.
Often due to the stretch on the lienorenal ligament, kidney enlarges on intravenous pyelography[1] but rarely clinically palpable. With splenectomy it regains its size.
The spleen may show chronic fibrotic changes or may be normal.
The treatment is splenectomy which is made easy by its long pedicle.[8]
Thanks are due to the Dean, K.E.M. Hospital. Bombay, for permitting us to report the hospital data.
| 1. | Abell, Irvin: Wandering spleen with torsion of the pedicle. Ann. Surg., 98: 722-732, 1938.  |
| 2. | Adkins, E. H.: Ptosed spleen with torsion of pedicle. Ann. Surg., 107: 832-835, 1938. |
| 3. | Chamberlain, D.: The spleen and its removal. Bradshaw Lecture delivered at the Royal College of Surgeons on 9th November 1961. Ann. Royal Coll. Surg. Eng., 30: 1-22, 1962. |
| 4. | Hall, C. L.: Wandering spleen during first decade of life. Brit. Med. J., 1: 957-958, 1952. |
| 5. | Love and Bailey's "Short Practice of Surgery," 17th Ed., Revised by A. J. Harding-Rains and David Ritchie. H. K. Lewis & Co., London, 1977, p. 832. |
| 6. | Maingot, Rodney: "Abdominal Operations," 6th Ed., Vol. I, Appleton-Century Crofts, New York, 1974, pp. 706-707. |
| 7. | Maingot, Rodney: Splenectomy; indications and technique. Lancet, 1: 625-629, 1952. |
| 9. | Tresdale, P. E. and Freedman, D.: Wandering spleen with torsion of the pedicle. Surgery, 4: 700-707, 1938. |
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