Yücel Ergün, Kurt Yavuz, Ozdemir Yavuz, Gun Ismet, Yildiz Mehmet
Department of General Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Üsküdar, Istanbul, Turkey.
Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):e102-4. doi: 10.1097/SLE.0b013e318246beb5.
Laparoscopic splenectomy became the gold standard recently for the removal of spleen. One of its rare indication is wandering spleen (WS). WS is characterized by incomplete fixation of the spleen. Patients usually have an asymptomatic abdominal mass. When they are symptomatic, abdominal pain with a mobile mass is the major finding. Laboratory data are nonspecific, but the diagnosis can be confirmed by imaging studies; computed tomography, magnetic resonance imaging, and ultrasonography are preferred modalities. It can predispose one to life-threatening complications such as splenic infarction, portal hypertension, pancretitis, and hemorrhage, due to torsion of its vascular pedicle. Herein, we present a female patient, a 24-year-old, 18-week primigravida. She was admitted with an intra-abdominal mass and lower abdominal pain. Ultrasonography revealed a mass behind the uterus. Magnetic resonance imaging was planned, and the spleen was seen at this area. We performed laparoscopic splenectomy for the treatment of a WS, which would be dangerous for pregnancy. The patient was discharged without any postoperative complication on the third day postoperatively. A healthy baby was delivered at term. Minimally invasive procedures should also be the primary choice in the treatment of such pregnant women. This is the first case of laparoscopic splenectomy in a pregnant woman for WS in the English literature.
腹腔镜脾切除术近来已成为脾脏切除的金标准。其罕见适应证之一是游走脾(WS)。游走脾的特点是脾脏固定不完全。患者通常有无症状的腹部肿块。当出现症状时,主要表现为伴有可移动肿块的腹痛。实验室检查数据无特异性,但可通过影像学检查确诊;计算机断层扫描、磁共振成像和超声检查是首选的检查方式。由于其血管蒂扭转,游走脾可导致危及生命的并发症,如脾梗死、门静脉高压、胰腺炎和出血。在此,我们报告一名24岁、孕18周的初产妇女性患者。她因腹部肿块和下腹痛入院。超声检查发现子宫后方有一肿块。计划进行磁共振成像检查,在此区域发现了脾脏。我们对该游走脾患者进行了腹腔镜脾切除术,因为这对妊娠有危险。患者术后第三天无任何并发症出院。足月分娩出一个健康婴儿。对于此类孕妇的治疗,微创手术也应作为首选。这是英文文献中首例因游走脾行腹腔镜脾切除术的孕妇病例。