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一名10岁儿童的巨大游走脾伴扭转及梗死:病例报告与文献综述

Massively Enlarged Wandering Spleen With Torsion and Infarction in a 10-Year-Old: Case Report and Comprehensive Literature Review.

作者信息

Sawaftah Zaid, Sawafta Omar, Rajha Humam Emad, Hassouneh Ammar, Tawfiq Anati Mosaikah D, Hussein Abdallah H, Abuayash Ahmad M, Taha Haya Tariq, Rajab Islam

机构信息

Department of Medicine, An Najah National University, Nablus, State of Palestine.

College of Medicine, QU Health, Qatar University, Doha, Qatar.

出版信息

Case Rep Pediatr. 2025 Aug 6;2025:9927034. doi: 10.1155/crpe/9927034. eCollection 2025.


DOI:10.1155/crpe/9927034
PMID:40808892
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12349995/
Abstract

Wandering spleen (WS) is a rare condition characterized by abnormal splenic mobility due to congenital absence or acquired laxity of its suspensory ligaments. It is more prevalent in children and women of childbearing age and may present asymptomatically or with acute abdominal symptoms due to splenic torsion, which can lead to infarction or rupture. We report a case of a 10-year-old female who presented with a 4-day history of persistent nonbilious vomiting, generalized abdominal pain, and fever. Physical examination revealed a rigid abdomen with tenderness and guarding in the right iliac fossa. Abdominal ultrasound demonstrated an ectopic, enlarged spleen (19 cm) in the lower abdomen, with absent blood flow on Doppler imaging. A contrast-enhanced computed tomography (CT) confirmed splenic torsion, showing the spleen in the mid-abdomen with twisted vascular pedicle and hypoperfusion. The patient underwent urgent splenectomy due to ischemic changes and infarction. Postoperatively, she recovered uneventfully and remained stable during follow-up. WS may be congenital, due to incomplete fusion of the dorsal mesentery, or acquired, associated with factors such as pregnancy or chronic splenomegaly. Splenic torsion is the most severe complication, requiring prompt intervention. Imaging modalities such as Doppler ultrasound and CT are critical for diagnosis. Splenopexy is the treatment of choice for viable spleens, whereas splenectomy is necessary for infarcted spleens. WS is a rare, clinically challenging diagnosis requiring high suspicion. Early imaging and surgical intervention are essential to prevent life-threatening complications.

摘要

游走脾(WS)是一种罕见病症,其特征是由于脾悬韧带先天性缺失或后天松弛导致脾脏活动异常。它在儿童和育龄女性中更为常见,可能无症状,也可能因脾扭转出现急性腹部症状,进而导致梗死或破裂。我们报告一例10岁女性病例,该患者有持续4天的非胆汁性呕吐、全腹痛和发热病史。体格检查发现腹部僵硬,右下腹有压痛和反跳痛。腹部超声显示下腹部有一个异位、肿大的脾脏(19厘米),多普勒成像显示无血流信号。增强计算机断层扫描(CT)证实了脾扭转,显示脾脏位于中腹部,血管蒂扭曲且灌注不足。由于出现缺血性改变和梗死,患者接受了紧急脾切除术。术后,她恢复顺利,随访期间保持稳定。游走脾可能是先天性的,由于背侧肠系膜融合不全所致,也可能是后天性的,与妊娠或慢性脾肿大等因素有关。脾扭转是最严重的并发症,需要及时干预。多普勒超声和CT等影像学检查对诊断至关重要。对于可存活的脾脏,脾固定术是首选治疗方法,而对于梗死的脾脏则需要进行脾切除术。游走脾是一种罕见的、临床诊断具有挑战性的疾病,需要高度怀疑。早期影像学检查和手术干预对于预防危及生命的并发症至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3514/12349995/cc7450eb0c82/CRIPE2025-9927034.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3514/12349995/c4e02d090b94/CRIPE2025-9927034.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3514/12349995/cc7450eb0c82/CRIPE2025-9927034.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3514/12349995/c4e02d090b94/CRIPE2025-9927034.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3514/12349995/cc7450eb0c82/CRIPE2025-9927034.002.jpg

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本文引用的文献

[1]
Wandering spleen with torsion causing an acute abdomen: A case report.

Int J Surg Case Rep. 2025-1

[2]
Spontaneous splenic rupture as a primary manifestation of angiosarcoma: a case report.

J Surg Case Rep. 2024-10-8

[3]
Wandering spleen combined with pedicle torsion and splenic infarction: a rare case report and literature review.

Front Pediatr. 2024-9-16

[4]
Wandering spleen: Diagnosis and treatment.

J Visc Surg. 2024-12

[5]
Wandering Spleen with Splenic Torsion: Unusual Cause of Acute Abdomen.

Int Med Case Rep J. 2022-11-4

[6]
Wandering spleen with torsion and infarction: A case report.

Radiol Case Rep. 2022-7-18

[7]
Wandering spleen with torsion: a rare cause of acute abdomen in a 14-year-old girl.

Arch Clin Cases. 2022-7-7

[8]
Wandering spleen with splenic arteriovenous torsion.

Clin Case Rep. 2021-11-7

[9]
Acute abdomen due to torsion of the wandering spleen: A rare clinical presentation.

Ulus Travma Acil Cerrahi Derg. 2021-1

[10]
Wandering Spleen.

N Engl J Med. 2020-11-19

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