Laparoscopic Splenopexy for the Wandering Spleen Syndrome

Abstract

Purpose

: Wandering spleen syndrome is an uncommon condition characterized by the absence of the normal suspensory ligaments of the spleen. The wandering spleen is highly mobile, suspended only by its vascular pedicle, and may cause significant morbidity, including hypersplenism, splenic torsion and infarction, pancreatitis, intestinal obstruction, and bleeding from gastric varices. Splenectomy has been the traditional method of treatment; however, splenopexy has recently been advocated to avoid the risk for post-splenectomy sepsis. We present a novel, minimally invasive method of splenopexy for the treatment of a wandering spleen and associated hypersplenism in a pediatric patient.

Methods

: A 15-year-old girl presented with a 3-week history of intermittent severe lower abdominal pain and was found to have anemia, thrombocytopenia, and a palpable lower abdominal mass. Ultrasonography demonstrated an enlarged wandering spleen and cholelithiasis. Laparoscopic splenopexy and cholecystectomy were performed without complications. An absorbable polyglycolic acid mesh was used to secure the spleen to the subdiaphragmatic surface of the left upper quadrant.

Results

: The patient had an uneventful perioperative course and was discharged home on the first postoperative day. At evaluations performed 2 and 5 months postoperatively, the spleen was located in the left upper quadrant and had returned to normal size by ultrasonography. The patient's abdominal symptoms and signs of hypersplenism have resolved.

Conclusions

: Laparoscopic splenopexy with splenic conservation can be performed safely to treat a wandering spleen. The hematologic derangements of hypersplenism can be reversed after successful splenopexy.