Wandering spleen associated with gastric volvulus
Publication Date: 2008-06-10
IMAGES 3- 8 : CT Abdomen and Pelvis: selected axial, coronal and sagittal images demonstrate an abnormal configuration of the stomach which is severely dilated and filled with fluid. Coronal and sagittal images best depict that the stomach antrum has a beaked or tapered appearance and is superiorly located. The spleen is normally perfused but seen in the right lower quadrant and midline
IMAGES 9-12 : UGI selected images depict a markedly distended stomach with the gastroduodenal junction in an abnormal position in the left upper quadrant superior to the GE junction. Slow gastric emptying was present. The duodenum and proximal small bowel are in an abnormal position in the right abdomen consistent with malrotation or nonfixation.
Gastric volvulus, rarely seen in children, is an abnormal degree of rotation of one part of the stomach around another and can result in gastric inlet or outlet obstruction. Two types of gastric volvulus occur: organoaxial and mesenteroaxial. Organoaxial volvulus is more common, and is rotation around the longitudinal axis of the stomach, such that the greater curvature of the stomach is superior to the lesser curvature. Mesenteroaxial volvulus is rotation of the stomach around the mesenteric axis (at a right angle to the lesser/greater curvature). In an acute setting, volvulus may progress to ischemia and necrosis of the stomach as well as perforation.
Wandering spleen is also a rare condition characterized by the absence or underdevelopment of one or all of the ligaments that hold the spleen in its normal position in the left upper quadrant of the abdomen. A wandering spleen is a mobile spleen that is only attached by an elongated vascular pedicle. This allows it to migrate anywhere within the abdomen or pelvis. Recognizing the presence of a wandering spleen is important because it is prone to splenic torsion.
Wandering spleen and gastric volvulus share a common cause which is the absence of an intraperitoneal visceral ligament resulting in nonfixation. A wandering spleen has a very rare association with gastric volvulus.
Although rare, it is important to remember both of these entities and their association, as both splenic torsion and gastric volvulus are potentially life-threatening if not immediately managed surgically.
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