Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon.

Posted By Enrique Flores
Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon.

A 22-year-old woman with history of mental retardation and epilepsy was admitted to the Emergency Department with abdominal pain and vomiting. The physical examination revealed a marked abdominal distension with diffuse tenderness but without signs of peritoneal irritation. Vital signs and laboratory tests showed no remarkable abnormalities. Plain abdominal radiography showed severe gastric distension, empty splenic fossa and a large mass in the right iliac fossa (Fig 1) moveable in the left lateral decubitus projection (Fig.2) Contrast-enhanced computed tomography (CT) scan demonstrated severe gastric dilatation with the pylorus lying at the level of the gastroesophageal junction due to mesenteroaxial volvulus. An enlarged spleen with poor enhancement of the upper pole was located in the right iliac fossa (Fig.3). A pancreatic volvulus (Fig.4) and an anomalous rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon were also seen. (Fig.5). The splenic vessels were forming a twist leading to enlarged splenic vein secondary to congestion. The liver showed peripheral enhanced areas reflecting increased arterial blood flow due to a reduced portal venous flow (Fig. 3). An urgent upper digestive endoscopy was performed. Mild erosions in the distal esophagus and a huge distension of the stomach that required the aspiration of approximately 4 liters of liquid with fecaloid aspect, and a pre-pyloric retraction with secondary volvulation. An endoscopic devolvulation was subsequently performed, with resolution of the gastric volvulus. After endoscopic devolvulation, plain abdominal radiography confirmed the return of the spleen to its normal position (Fig.6). The patient was discharged on seventh day remaining asymptomatic. Wandering spleen is a rare condition,characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries. Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported.

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  • Enrique Flores 2015-01-05 15:19:40



  • Tony 2015-01-05 05:44:06

    Any vascular study available (e.g. CTA)


  • Anonymous 2015-01-02 16:43:14

    Nice case!