Splenomegalia in sede pelvica. Milza ptosica, migrante o accessoria?


COD: 05_2009_395-398 Categorie: ,

Antonio Biondi, Salvatore Motta, Michela Di Giunta, Domenico Rapisarda, Debora Simona Fichera, Carmelo La Greca, Roberto Ciuni, Francesco Basile

Ann. Ital. Chir., 2009; 80: 395-397

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A wandering or ectopic spleen is a rare condition in which the spleen is not located in the left upper quadrant but is
found lower in the abdomen or in the pelvic region caused by improper fixation of the ligamentous attachments. Laxity
of the peritoneal attachments of the spleen results in splenic hyper mobility, known as wandering spleen. Congenital and
acquired causes have been advocated to explain its onset. However, the precise aetiology is not completely understood.
Many patients with wandering spleen are asymptomatic and therefore, the real incidence is unknown. Symptomatic
patients may have intermittent abdominal pain because of splenic congestion with intermittent torsion of the splenic pedicle
and its spontaneous detorsion, or may present acutely with pedicle torsion with subsequent infarction. Pain and dangerous
potential evolution recommend surgery, splenoplexy or splenectomy.
The Authors report the case of a 48 years old man with painful abdominal mass suspected for wandering splenomegaly
after diagnostic imaging (abdominal Ultrasonography and TC). Laparotomy evidenced a large spleen (DL 22 cm.) with
a long (1 mt) and tortuous vascular pedicle, both removed. Histopathologic examination showed partial infarction of the
spleen. The postoperative course was uneventful.


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