Inggriani Sri, Sulay Callistus Bruce Henfry, Octavius Gilbert Sterling
Abdominal Radiology, Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 12930, Indonesia.
Medistra Hospital, Jakarta 12950, Indonesia.
Reports (MDPI). 2024 Sep 2;7(3):73. doi: 10.3390/reports7030073.
Wandering spleen (WS) is a rare condition often linked with torsion or infarction, but its association with Bochdalek hernia, acute appendicitis, and thrombocytopenia is exceptionally rare. We present a case of a nine-year-old girl who was admitted with acute abdominal pain, later diagnosed with WS, Bochdalek hernia, and acute appendicitis. A literature search was performed on PubMed and Google Scholar on 30 May 2024 with keywords including "Wandering spleen" and ("Bochdalek Hernia" OR "Sepsis" OR "Acute Appendicitis" OR "Thrombocytopenia"). The management was complicated by severe thrombocytopenia and post-operative sepsis, with as the causative agent. Imaging revealed an abnormally located spleen and significant splenic enlargement over time. The patient's condition was managed non-operatively concerning the WS, avoiding splenectomy due to the risks of post-splenectomy sepsis. Instead, laparotomy was performed to address the appendicitis and diaphragmatic hernia. The patient experienced post-operative complications, including a seizure and persistent fever, which resolved with appropriate antibiotic therapy. This case underscores the complexity of managing WS with concurrent severe conditions, highlighting the importance of individualised treatment strategies. It also emphasises the need for further studies to explore optimal treatment modalities for such rare and complex presentations. This case serves as an educational example in clinical settings, demonstrating the challenges and considerations when treating multiple rare pathologies simultaneously.
游走脾（WS）是一种罕见病症，常与扭转或梗死相关，但它与博赫dalek疝、急性阑尾炎和血小板减少症的关联极为罕见。我们报告一例9岁女孩，因急性腹痛入院，后来被诊断为游走脾、博赫dalek疝和急性阑尾炎。于2024年5月30日在PubMed和谷歌学术上进行了文献检索，关键词包括“游走脾”以及（“博赫dalek疝”或“脓毒症”或“急性阑尾炎”或“血小板减少症”）。治疗因严重血小板减少症和术后脓毒症而变得复杂， 为病原体。影像学检查显示脾脏位置异常且随时间显著肿大。鉴于游走脾，患者的病情采用非手术治疗，由于脾切除术后脓毒症的风险而避免进行脾切除术。取而代之的是，进行剖腹手术以处理阑尾炎和膈疝。患者术后出现并发症，包括癫痫发作和持续发热，经适当的抗生素治疗后得到缓解。该病例强调了在伴有并发严重病症的情况下管理游走脾的复杂性，突出了个体化治疗策略的重要性。它还强调需要进一步研究以探索针对此类罕见且复杂病症的最佳治疗方式。该病例在临床环境中作为一个教育实例，展示了同时治疗多种罕见病症时的挑战和注意事项。
