𝗪𝗮𝗻𝗱𝗲𝗿𝗶𝗻𝗴 𝗦𝗽𝗹𝗲𝗲𝗻’ 𝗼𝗿 ‘𝗣𝘁𝗼𝘁𝗶𝗰 𝗦𝗽𝗹𝗲𝗲𝗻’ 𝗼𝗿 ‘𝗛𝘆𝗽𝗲𝗿𝗺𝗼𝗯𝗶𝗹𝗲 𝗦𝗽𝗹𝗲𝗲𝗻’:
-It results from the elongation or maldevelopment of spleen’s 𝖲𝗎𝗌𝗉𝖾𝗇𝗌𝗈𝗋𝗒 𝗅𝗂𝗀𝖺𝗆𝖾𝗇𝗍𝗌.
“𝗧𝗵𝗲 𝗺𝗮𝗹-𝗮𝘁𝘁𝗮𝗰𝗵𝗲𝗱 𝘀𝗽𝗹𝗲𝗲𝗻 𝗵𝗮𝘀 𝘁𝗵𝗲 𝗶𝗻𝗰𝗿𝗲𝗮𝘀𝗲𝗱 𝗿𝗶𝘀𝗸 𝗼𝗳 𝘁𝗼𝗿𝘁𝗶𝗼𝗻 & 𝗶𝘁 𝗰𝗮𝗻 𝗹𝗲𝗮𝗱 𝘁𝗼 𝘀𝗽𝗹𝗲𝗻𝗶𝗰 𝗶𝘀𝗰𝗵𝗲𝗺𝗶𝗮 & 𝗶𝗻𝗳𝗮𝗿𝗰𝘁𝗶𝗼𝗻”
The spleen is normally fixed in this position by gastrosplenic and lienorenal ligaments. Congenitally, wandering spleen is the result of failure of development of these ligaments, which results in long splenic mesentery. The spleen develops in the dorsal mesogastrium, and through rotation of the gut it moves posterolaterally to the left. Fusion of the dorsal mesogastrium to the posterior abdominal wall and the left kidney forms the lienorenal ligament, which contains the tail of the pancreas and the splenic artery.
“𝗦𝗽𝗹𝗲𝗲𝗻 𝗺𝗮𝘆 𝗽𝗿𝗲𝘀𝗲𝗻𝘁 𝗶𝗻 𝗽𝗲𝗹𝘃𝗶𝘀 𝗼𝗿 𝘀𝗼𝗺𝗲𝘄𝗵𝗲𝗿𝗲 𝗲𝗹𝘀𝗲”
-It is a rare clinical entity that mainly affects 𝙘𝙝𝙞𝙡𝙙𝙧𝙚𝙣𝙨 or in prune-Belly syndrome, splenomegaly due to hemolytic disorders & situs inversus. -Among adults, it is most commonly found in 𝙛𝙚𝙢𝙖𝙡𝙚𝙨 of active 𝙧𝙚𝙥𝙧𝙤𝙙𝙪𝙘𝙩𝙞𝙫𝙚 age. (Pregnancy may contribute to ligamentous lengthening due to laxity of the abdominal wall and hormonal changes).
-It may present as an asymptomatic mass in the abdomen, or it may present with intermittent abdominal discomfort because of torsion and spontaneous detorsion of the spleen & 𝙥𝙚𝙧𝙨𝙞𝙨𝙩𝙖𝙣𝙩 𝙩𝙤𝙧𝙩𝙞𝙤𝙣 𝙘𝙖𝙪𝙨𝙚𝙨 𝙖𝙘𝙪𝙩𝙚 𝙖𝙗𝙙𝙤𝙢𝙚𝙣.
The various techniques of splenopexy have been described in the literature:
Splenopexy in an extra peritoneal pouch.
Disconnecting the gastrocolic ligament, placing the spleen at its anatomical position, and then replacing the stomach and colon; suturing the greater curvature of the stomach to the anterior abdominal wall.
Suturing the splenic hilum to the splenic bed .
Splenic snood fixation with absorbable mesh wrap.
Currently, splenic surgery by 𝗹𝗮𝗽𝗮𝗿𝗼𝘀𝗰𝗼𝗽𝗶𝗰 approach is the preferred technique. This methods include creating a pouch in the omentum, stomach, or colon and the use of absorbable mesh to fix the spleen in its normal anatomical location.