๐ช๐ฎ๐ป๐ฑ๐ฒ๐ฟ๐ถ๐ป๐ด ๐ฆ๐ฝ๐น๐ฒ๐ฒ๐ปโ ๐ผ๐ฟ โ๐ฃ๐๐ผ๐๐ถ๐ฐ ๐ฆ๐ฝ๐น๐ฒ๐ฒ๐ปโ ๐ผ๐ฟ โ๐๐๐ฝ๐ฒ๐ฟ๐บ๐ผ๐ฏ๐ถ๐น๐ฒ ๐ฆ๐ฝ๐น๐ฒ๐ฒ๐ปโ:
-It results from the elongation or maldevelopment of spleenโs ๐ฒ๐๐๐๐พ๐๐๐๐๐ ๐ ๐๐๐บ๐๐พ๐๐๐.
โ๐ง๐ต๐ฒ ๐บ๐ฎ๐น-๐ฎ๐๐๐ฎ๐ฐ๐ต๐ฒ๐ฑ ๐๐ฝ๐น๐ฒ๐ฒ๐ป ๐ต๐ฎ๐ ๐๐ต๐ฒ ๐ถ๐ป๐ฐ๐ฟ๐ฒ๐ฎ๐๐ฒ๐ฑ ๐ฟ๐ถ๐๐ธ ๐ผ๐ณ ๐๐ผ๐ฟ๐๐ถ๐ผ๐ป & ๐ถ๐ ๐ฐ๐ฎ๐ป ๐น๐ฒ๐ฎ๐ฑ ๐๐ผ ๐๐ฝ๐น๐ฒ๐ป๐ถ๐ฐ ๐ถ๐๐ฐ๐ต๐ฒ๐บ๐ถ๐ฎ & ๐ถ๐ป๐ณ๐ฎ๐ฟ๐ฐ๐๐ถ๐ผ๐ปโ
๐๐๐ฉ๐๐ค๐๐๐ฃ๐๐จ๐๐จ:
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.
โ๐ฆ๐ฝ๐น๐ฒ๐ฒ๐ป ๐บ๐ฎ๐ ๐ฝ๐ฟ๐ฒ๐๐ฒ๐ป๐ ๐ถ๐ป ๐ฝ๐ฒ๐น๐๐ถ๐ ๐ผ๐ฟ ๐๐ผ๐บ๐ฒ๐๐ต๐ฒ๐ฟ๐ฒ ๐ฒ๐น๐๐ฒโ
-It is a rare clinical entity that mainly affects ๐๐๐๐ก๐๐ง๐๐ฃ๐จ or in prune-Belly syndrome, splenomegaly due to hemolytic disorders & situs inversus. -Among adults, it is most commonly found in ๐๐๐ข๐๐ก๐๐จ of active ๐ง๐๐ฅ๐ง๐ค๐๐ช๐๐ฉ๐๐ซ๐ age. (Pregnancy may contribute to ligamentous lengthening due to laxity of the abdominal wall and hormonal changes).
๐๐น๐ถ๐ป๐ถ๐ฐ๐ฎ๐น ๐๐ฒ๐ฎ๐๐๐ฟ๐ฒ๐:
-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 & ๐ฅ๐๐ง๐จ๐๐จ๐ฉ๐๐ฃ๐ฉ ๐ฉ๐ค๐ง๐ฉ๐๐ค๐ฃ ๐๐๐ช๐จ๐๐จ ๐๐๐ช๐ฉ๐ ๐๐๐๐ค๐ข๐๐ฃ.
๐ ๐ฎ๐ป๐ฎ๐ด๐บ๐ฒ๐ป๐:
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 ๐น๐ฎ๐ฝ๐ฎ๐ฟ๐ผ๐๐ฐ๐ผ๐ฝ๐ถ๐ฐ 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.