Department of Surgery, Summa Health System, Akron, OH, USA.
Division of Pediatric General Surgery, Akron Children's Hospital, One Perkins Sq, Suite 8400, Akron, OH, 44308, USA.
Surg Endosc. 2017 Dec;31(12):5427-5428. doi: 10.1007/s00464-017-5630-x. Epub 2017 Jul 21.
Wandering spleen is a rare clinical entity caused by absence of the spleen's peritoneal attachments, allowing the spleen to move freely within the peritoneal cavity [1]. This disease is most commonly seen in children and young women [1, 2]. Affected individuals are predisposed to complications including splenic torsion, splenic infarction, and pancreatic necrosis [3, 4]. Patients may present with constipation, an abdominal mass, swelling, or acute abdominal pain if splenic torsion has occurred [4]. Wandering spleen is difficult to diagnose without imaging, as symptoms are non-specific or may be absent. Imaging studies to confirm the diagnosis may include computed tomography (CT) scan or duplex ultrasonography [5]. Definitive management of a wandering spleen is primarily surgical [2]. Splenectomy is the preferred treatment in patients who present with an acute splenic infarction [2, 6]. Splenopexy, however, is first line treatment for patients with a non-infarcted wandering spleen [2, 7, 8].
In this video, we present a case of an 11 year old male with a symptomatic wandering spleen who was treated at our institution with laparoscopic splenopexy. The patient had a history of arthrogryposis multiplex congenita and presented with recurrent, episodic abdominal pain, nausea, and vomiting. The diagnosis was confirmed by CT scan which demonstrated the spleen in the right lower quadrant. We performed laparoscopic splenopexy by encircling the spleen with polyglactin 910 woven mesh and attaching the mesh to the left lateral abdominal wall with absorbable tacks.
Our surgical technique for splenopexy was successful and the patient returned home on postoperative day four. No significant complications occurred. This video demonstrates this technique and highlights the key steps. Splenopexy by encircling the spleen with polyglactin 910 mesh is feasible, preserves splenic function, and can be performed with standard laparoscopic equipment. Tacks or transfascial sutures are a potential option for securing mesh.
游走脾是一种罕见的临床病症，由脾腹膜附着缺失引起，导致脾脏在腹膜腔内自由移动[1]。这种疾病最常见于儿童和年轻女性[1,2]。受影响的个体易发生并发症，包括脾扭转、脾梗死和胰腺坏死[3,4]。如果发生脾扭转，患者可能会出现便秘、腹部肿块、肿胀或急性腹痛[4]。如果没有影像学检查，游走脾很难诊断，因为症状不特异或可能不存在。用于确认诊断的影像学检查可能包括计算机断层扫描（CT）或双功能超声[5]。游走脾的主要治疗方法是手术[2]。脾切除术是急性脾梗死患者的首选治疗方法[2,6]。然而，对于非梗死性游走脾患者，脾固定术是一线治疗方法[2,7,8]。
在这段视频中，我们介绍了一例 11 岁男性游走脾病例，他在我院接受了腹腔镜脾固定术治疗。该患者有先天性多发关节挛缩症病史，表现为反复发作的间歇性腹痛、恶心和呕吐。CT 扫描证实了诊断，显示脾脏位于右下象限。我们通过用聚乳酸 910 编织网环绕脾脏，并使用可吸收钉将网固定到左外侧腹壁来进行腹腔镜脾固定术。
我们的脾固定术技术成功，患者在术后第四天出院回家。没有发生明显的并发症。本视频演示了该技术，并强调了关键步骤。用聚乳酸 910 网环绕脾脏进行脾固定术是可行的，保留了脾脏功能，并且可以使用标准的腹腔镜设备进行操作。钉或经筋膜缝合线是固定网的潜在选择。
