Our Summary

This paper discusses an unusual case of a twisted wandering spleen in a patient with a blood disease. A 66-year-old Japanese woman came to the hospital with stomach pain and a fever. She had a history of too many red blood cells and a type of bone marrow disorder. A scan of her abdomen showed a larger than normal spleen in the lower belly area. The doctors concluded that her wandering spleen had severely twisted and required surgery. They performed a procedure to remove the spleen after untwisting it to restore blood supply. After the surgery, the patient’s blood platelet count gradually increased and she was given aspirin to prevent blood clots.

FAQs

  1. What is a wandering spleen and how is it related to torsion?
  2. How is a splenectomy performed in the case of severe torsion of a wandering spleen?
  3. Why is aspirin administered after a splenectomy operation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about splenectomy is to be aware of the potential risks and complications associated with the surgery. These can include infection, bleeding, and the development of blood clots. It is important for patients to follow their doctor’s post-operative instructions carefully, including taking prescribed medications and avoiding certain activities that may increase the risk of complications. Additionally, patients should be vigilant for any signs of infection or other complications and contact their doctor immediately if they experience any concerning symptoms.

Suitable For

Patients who are typically recommended for splenectomy include those with:

  1. Severe splenomegaly: Enlargement of the spleen can lead to complications such as pain, thrombocytopenia, and hypersplenism.

  2. Hereditary spherocytosis: A condition characterized by abnormalities in red blood cells, which can lead to an enlarged spleen.

  3. Idiopathic thrombocytopenic purpura (ITP): A condition in which the immune system destroys platelets, leading to low platelet counts and an increased risk of bleeding.

  4. Sickle cell disease: A genetic disorder that causes red blood cells to become rigid and sickle-shaped, leading to an increased risk of infections and other complications.

  5. Trauma: In cases of severe trauma to the spleen, such as in a car accident or sports injury, splenectomy may be necessary to control bleeding.

  6. Wandering spleen: A rare condition in which the spleen is not in its usual position in the abdomen, leading to a risk of torsion and infarction.

  7. Myeloproliferative diseases: Disorders of the bone marrow that lead to an overproduction of blood cells, such as polycythemia and myelofibrosis, can result in an enlarged spleen and may require splenectomy.

Timeline

Before splenectomy:

  1. Patient presents with symptoms such as abdominal pain and fever.
  2. Medical history reveals underlying condition such as myeloproliferative disease.
  3. Imaging studies show an enlarged spleen without enhancement in the lower pelvic region.
  4. Clinical diagnosis is severe torsion of a wandering spleen.
  5. Surgical intervention is deemed necessary.

After splenectomy:

  1. Splenectomy is performed after de-rotating to revascularize the spleen.
  2. Platelet count gradually increases post-operation.
  3. Aspirin is administered to prevent thrombosis.
  4. Follow-up care and monitoring for any complications related to splenectomy.

What to Ask Your Doctor

  1. What are the reasons for considering a splenectomy in my case?
  2. What are the potential risks and complications associated with a splenectomy?
  3. How will a splenectomy affect my overall health and immune system function?
  4. Will I need to take any medications or make lifestyle changes after the splenectomy?
  5. What is the recovery process like after a splenectomy, and how long will it take?
  6. Are there any long-term effects or considerations to be aware of after a splenectomy?
  7. How will a splenectomy impact my existing medical conditions, such as myeloproliferative disease?
  8. Are there any alternative treatments or options to consider before proceeding with a splenectomy?
  9. What is the success rate of a splenectomy in cases like mine, and what are the expected outcomes?
  10. Are there any specific follow-up appointments or tests I should undergo after the splenectomy?

Reference

Authors: Imawari K, Uojima H, Hayama K, Toshimitsu F, Sanoyama I, Iwasaki S, Wada N, Kubota K, Hidaka H, Nakazawa T, Shibuya A, Suzuki T, Kumamoto Y, Saegusa M. Journal: Intern Med. 2022 Jul 15;61(14):2143-2148. doi: 10.2169/internalmedicine.8391-21. Epub 2021 Dec 11. PMID: 34897151