**6.1 Abdominal sonogram**

210 Updated Topics in Minimally Invasive Abdominal Surgery

This pathology is also found in children seemingly affecting more boys than girls (Allen & Andrews, 1989; François-Fiquet et al, 2009; Fiquet-François et al, 2010). This condition can occur very early on as seen in neonatal cases (Balliu et al, 2004; Fiquet-François et al, 2010, Arleo et al, 2010). During the first years of life the sex ratio is probably reversed. (Brown et

The diagnosis of wandering spleen is extremely difficult since it is such a rare condition and is clinically non-specific. In our recent multicenter study in children (Fiquet-François et al, 2010), we reported that the abdominal pain is at the forefront of all symptoms (93 % of cases), and its severity brings 86% of all cases to Emergency Room care. Furthermore, in 57% of all cases it was their first symptomatic episode of this type. The pain location is clinically non-specific: diffuse, periumbilical, left side, pelvis, left hypochondrium… Vomiting can be associated in 57% of cases. None of the diagnoses of wandering spleen were based on clinical evidence only. Even if the diagnosis cannot solely be based on clinical observations, it is important to note that the clinical presentation for wandering spleen can be either acute or chronic pain (Fiquet-François et al, 2010). The acute clinical pictures require emergency

The acute clinical picture can show two types of presentations: splenic torsion but also

This is the main complication of wandering spleen, it usually reveals this abnormality. Pain is at the forefront of the symptoms. Splenic torsion is an emergency situation as it can quickly lead to irreversible splenic ischemia. In our series (François-Fiquet et al, 2010), 6 patients (43%) had splenectomy for splenic ischemia, but the torsion can complicate up to

The clinical picture groups together painful symptoms associated to high occlusion with

Gastric volvulus associated to wandering spleen is a rare condition, and its quick clinical improvement with a simple medical treatment often delays the diagnosis and access to proper surgical care (Fiquet-François et al, 2010; François-Fiquet 2009; Spector & Chappell, 2000; Qazi & Awadalla, 2004). The semiological difficulty is quite real when faced with complex clinical pictures associating gastric volvulus, wandering spleen and even in some

The combination of wandering spleen and gastric volvulus should be explored by

Between 39% and 43% of children treated for wandering spleen had already presented similar symptoms. (Brown et al, 2003; Fiquet-François et al, 2010). Most often these children had been complaining about non-systematic recurrent but inconsistent abdominal pain for

additional imaging exams, and requires a quick and adapted therapeutic care.

al, 2003)

**5. Clinical pictures** 

surgery because of the high risk of ischemia.

gastric volvulus, associated or not to splenic torsion.

65% of pediatrics cases (Romero & Barksdale, 2003).

cases a diaphragmatic hernia (Liu & Lau, 2007).

**5.2 Chronic clinical picture** 

**5.1.2 Gastric volvulus +/- associated to splenic torsion** 

vomiting. In some cases patients can be in a real state of shock.

**5.1 The acute clinical picture** 

**5.1.1 Splenic torsion** 

An abdominal sonogram is the current diagnostic modality of choice for wandering spleen since it can validate the diagnosis without using radiation. (Fiquet-François et al, 2010; Brown et al, 2003; Di Crosta et al, 2009; Karmazyn et al, 2005).

It is essential to ask the radiologists to correctly evaluate the location and viability of the spleen when faced with gastric volvulus, but also dull abdominal pain.
