**4. Epidemiology**

208 Updated Topics in Minimally Invasive Abdominal Surgery

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

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

diaphragmatic hernia can also generate acquired wandering spleen.

As discussed above, CDH can be associated to wandering spleen; in fact traumatic

Malarial infection has not been clearly validated as responsible for the onset of secondary

wandering spleen, but it can clearly trigger the pathology, asymptomatic until then.

splenorenal ligament.

**3.2.3 Malarial infection** 

**3.2.2 Traumatic diaphragmatic hernia** 

abdominal pain in a patient having a history of subtotal splenectomy.

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 underestimated.

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 twin pregnancy.

Laparoscopic Gastropexy

**6.1 Abdominal sonogram** 

diagnosis when faced with an atypical clinical picture.

Brown et al, 2003; Di Crosta et al, 2009; Karmazyn et al, 2005).

**6.2 CT-scan and abdominal magnetic resonance imaging** 

recommended for uncomplicated chronic types.

indicated for follow-up and monitoring exams.

quick diagnosis of gastric volvulus (Fig 10).

diagnosis will only be validated during surgery.

**7. Complications of wandering spleen** 

**6.3 Dynamic sonogram** 

**6.4 Plain abdomen radiography** 

spleen when faced with gastric volvulus, but also dull abdominal pain.

**6. Additional imaging examinations** 

for the Treatment of Wandering Spleen With or Without Gastric Volvulus 211

the past months (even several years). Some children were even hospitalized several times before making a proper diagnosis. This is mostly due to the quick clinical improvement when the child was lying down (Fiquet-François et al, 2010; François-Fiquet et al, 2009). The chronic clinical picture once again underlines the difficulty in making a proper

Additional imaging examinations are key elements for the diagnostic evaluation of wandering spleen. The diagnosis cannot be made on non-specific clinical symptoms only.

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;

It is essential to ask the radiologists to correctly evaluate the location and viability of the

The efficacy of contrast enhanced CT-scan imaging has been validated and can be quite helpful in an emergency situation since it is not radiologist dependent and might sometimes be faster to access. Thus, it remains a perfect choice for acute pictures such as diagnostic evaluation of splenic torsion associated to a wandering spleen with a high risk of ischemia. It is the whorled appearance of the splenic vessels and surrounding fat that is considered pathognomonic of that condition. (Gomez et al, 2006). However even if this examination is well indicated in adults, CT-scan should remain a last-resort examination in children because of radiation exposure (Ben et al, 2006; Marinaccio et al, 2005). Abdominal magnetic resonance imaging (MRI) (Fig 7-8-9), since it does not require any anesthesia seems to be a good alternative to CT-scan for adults or older children with chronic pain. However, because it is not available in all clinical settings, it can limit its indications. It can also be

Dynamic sonogram (on the side, standing up) is a simple examination that can help define the splenic ptosis and be relevant for chronic and hard-to-identify cases. It is also properly

Plain abdomen radiography is still useful as first-line imaging examination. It allows for a

A well-designed imaging check-up can usually validate the diagnosis. But in some cases the

Splenic ischemia is the main complication of wandering spleen. It justifies in itself emergency therapeutic care. Gastric volvulus is a well-known complication of wandering

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 al, 2003)
