**3.2 Acquired form**

#### **3.2.1 Postoperative (subtotal splenectomy)**

Even if these data are not found in the literature, our multicenter study (Fiquet-François et al, 2010) reported 4 cases of wandering spleen post subtotal splenectomy. They were in fact excluded from the study that only focused on congenital forms. These cases are quite

Laparoscopic Gastropexy

congenital abnormality.

**4. Epidemiology** 

underestimated.

twin pregnancy.

for the Treatment of Wandering Spleen With or Without Gastric Volvulus 209

Cripps described the case of a patient who had a malarial infection at the age of 5 and the CT-Scan done at the time validated a normally located spleen. (Cripps et al, 2010) However at the age of 18 she developed clinical symptoms and the diagnosis concluded to wandering spleen that could have resulted from a congenital fusion anomaly or attenuation of the patient's suspensory ligaments caused by her previous malarial infection and splenomegaly. However we can wonder if the malarial splenomegaly did not simply unveil an underlying

Fig. 5. Frontal view. Peritoneal attachments of spleen. Stomach is retracted to the right

The incidence of wandering spleen is uncertain and difficult to assess. The diagnosis is often made following complications. The incidence of this pathology is probably dramatically

Romero and Barksdale evaluated the peak incidence for wandering spleen between the age of 20 and 40 (Romero & Barksdale, 2003; Lin et al, 2005). Generally, 70–80% of the reported cases occur in women of childbearing age. (Steinberg et al, 2002) Hormonal changes and fluctuations explain this female predominance in adults. Furthermore the literature has reported that potentially predisposing elements in this population include multiparity and abdominal laxity thought to be secondary to pregnancy-induced hormonal effects on the abdominal wall. (S. Zarrintan et al, 2007) Ghazeeri et al (Ghazeeri et al, 2010) reported the case of splenic torsion on wandering spleen in a pregnant woman in her twelfth week of

interesting and probably unveil a technical defect. When the subtotal splenectomy involves resection of the upper pole of the spleen, with the section of suspensory ligaments, promoting acquired wandering spleen. To avoid this type of complications it is preferable to preserve the upper pole of the spleen and promote resection of the lower pole. It is important to bring up the possibility of wandering spleen in case of sudden or chronic abdominal pain in a patient having a history of subtotal splenectomy.

Fig. 4. Sagittal section showing the Phrenogastric ligament. This ligament prolonge the splenophrenic ligament to the right, and this splenophrenic ligament is an extension of the splenorenal ligament.
