Wandering Spleen
rare but well-known entity, incidence is < 0.2%. more common in females than males in an adult population. Pregnant women and boys < 10. the spleen is supported by lienogastric, lienorenal, and phrenocolic ligaments A wandering spleen occurs when there is a failure of development or laxity of these supporting structures factors that have been proposed for causing laxity of these supporting structures include splenomegaly, trauma, abdominal laxity, gastric distension, and hormonal effects of pregnancy. The latter may account for the increased incidence of this condition in multiparous women The clinical presentation of a wandering spleen can be variable. Affected patients may be asymptomatic and this condition may be discovered incidentally as an abdominal mass on physical examination or on imaging for other unrelated reasons. Patients may have mild intermittent abdominal pain due to splenic congestion with intermittent torsion and spontaneous detorsion, or may present with an acute abdomen due to torsion of the splenic pedicle with subsequent infarction. With acute torsion, the condition can be confused with appendicitis or ovarian torsion. Other clinical symptoms include nausea, vomiting, fever, leukocytosis, peritoneal signs, and a palpable mass in the abdomen or pelvis. (J EM Aug 2003) Splenic Artery Aneurysm on CT - What Do You Tell The Patient? The splanchnic circulation includes the celiac, superior mesenteric, and inferior mesenteric arteries, which arise from the abdominal aorta. Autopsy studies suggest that splanchnic artery aneurysms may be more frequent than abdominal aortic aneurysms. Most aneurysms are asymptomatic and are detected incidentally on imaging studies. Splenic artery aneurysms are the most common of the splanchnic artery aneurysms which, if sufficiently calcified, may be found incidentally on plain radiographs of the abdomen. With the increasing use of abdominal CT scanning in Emergency Medicine practice, Emergency Physicians can expect to find splanchnic artery aneurysms as an incidental finding and need to understand their significance. Splanchnic artery aneurysms are important to recognize because of the risk for rupture and associated mortality. Management must be individualized according to the artery involved. Elective intervention is required for all symptomatic aneurysms and for most aneurysms > 2 cm in diameter to reduce the risk of rupture. Specifically regarding splenic aneurysms, a symptomatic aneurysm or a splenic aneurysm of any diameter in a pregnant woman or a woman of childbearing age is considered by some to be an absolute indication for elective repair. Most would agree that an aneurysm > 2 cm is an indication for surgery; an aneurysm between 1-2 cm should be monitored closely with imaging studies every 6 months. Transcatheter embolization may be considered for many splenic artery aneurysms.References: (1) Pasha SF, et al. Splanchnic artery aneurysms Mayo Clin Proc 2007;82:472-9. (2) Abbas MA, et al. Splenic artery aneurysms: two decades experience at Mayo Clinic Ann Vasc Surg 2002;16:442-449. (3) Grego FG, et al. Visceral artery aneurysms: a single center experience Cardiovasc Surg 2003;11:19-25. (EMEDhome)
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