General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
BMJ Case Rep. 2021 Feb 4;14(2):e238647. doi: 10.1136/bcr-2020-238647.
Wandering spleen (WS) is a hypermobile spleen that, due to the laxity of its ligaments, is prone to torsion. We report a case of a 45-year-old multiparous woman who presented with acute abdominal pain and a tender palpable mass. A contrast-enhanced computed tomography scan of the abdomen showed a WS with torsion. She underwent an emergency splenectomy and was discharged after an uneventful recovery. She was readmitted with splanchnic venous thrombosis and was managed with therapeutic low-molecular-weight heparin (LMWH) and discharged. Twenty days later, she presented with new-onset abdominal pain. She had not complied with LMWH as advised. The thrombosis had progressed, leading to small bowel gangrene, requiring resection and a stoma. Due to frequent metabolic disturbances, an early reversal of stoma was performed. She was lost to follow-up thereafter. This case highlights a rare indication for emergency splenectomy and one of its major postoperative complications.
游走脾(WS)是一种活动度较大的脾脏,由于其韧带松弛,容易发生扭转。我们报告了一例 45 岁多产妇,表现为急性腹痛和可触及的压痛肿块。腹部增强 CT 扫描显示 WS 伴扭转。她接受了紧急脾切除术,术后恢复顺利出院。她因脾静脉血栓形成再次入院,接受了低分子肝素(LMWH)治疗并出院。20 天后,她出现新的腹痛。她没有按照建议使用 LMWH。血栓进展导致小肠坏死,需要切除和造口。由于经常发生代谢紊乱,早期进行了造口逆转。此后她失去了随访。本例提示了急诊脾切除术的罕见适应证及其主要术后并发症之一。