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游走脾一例:急性腹痛的罕见病因

[A case of wandering spleen: a rare cause of acute abdomen].

作者信息

Salem Jean F, Tannouri Fadi, Salem Fouad

机构信息

Division of General Surgery, American University of Beirut Medical Center, Lebanon.

出版信息

J Med Liban. 2011 Jul-Sep;59(3):170-2.

Abstract

We present the case of a 17-year-old patient known to have an asymptomatic ectopic spleen, who presented with an acute abdomen. Clinical symptoms and ultrasound led to suspect an acute appendicitis, confirmed later on by pathology. Twenty-four hours after the appendectomy, the patient complained of an abdominal pain of acute onset. Torsion of the pedicle of the ectopic spleen was suspected. Imaging studies supported this diagnosis, and an urgent splenectomy was performed. Did the torsion happen by simple coincidence 24 hours after appendectomy, knowing that the spleen has been asymptomatic for 17 years, or was it precipitated by the surgical intervention? Should we have removed the ectopic spleen during the appendectomy? This is the first report of a case of torsion of a wandering spleen after a laparotomy; a review of the literature is done in order to explain the physiopathology of the disease, and to propose its management.

摘要

我们报告一例17岁患者,已知患有无症状异位脾,现出现急腹症。临床症状和超声检查怀疑为急性阑尾炎,后经病理证实。阑尾切除术后24小时,患者主诉突发腹痛。怀疑为异位脾蒂扭转。影像学检查支持这一诊断,遂行急诊脾切除术。考虑到脾脏17年来一直无症状,扭转是在阑尾切除术后24小时单纯巧合发生的,还是由手术干预诱发的?我们是否应该在阑尾切除术中一并切除异位脾?这是首例剖腹手术后游走脾扭转的病例报告;通过回顾文献来解释该疾病的生理病理学,并提出治疗方案。

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