![]() Organoaxial volvulus is the most common form accounting for approximately 60% of cases, being more frequent in adults. There are described 3 types of gastric volvulus according to the axis of rotation: organoaxial, mesenteroaxial and combination. In fact, both gastric volvulus and wandering spleen share a common mechanism, the abnormality of intraperitoneal visceral ligaments. It is thought to be secondary to hyperlaxity or absence of gastric ligaments. Gastric volvulus is an uncommon entity in adults characterized by an abnormal rotation of the stomach of more than 180° around one of its axis. Other features of vascular compromise and splenic infarctions include poor enhancement of splenic parenchyma, hyperattenuating pedicle on unenhanced CT due to acute thrombosis, or peripheral enhancement of splenic parenchyma (“pseudocapsule sign”) attributed to chronic ischemia and secondary perisplenic collateral circulation. The “whirl sign” of the splenic pedicle is highly specific and characteristic for splenic torsion and has been described in cases with pancreatic tail involvement, some of them associated with acute pancreatitis. Often, the spleen is rotated, more commonly counter-clockwise, and usually has vascular congestion signs, so that it may be also increased in size. CT confirms the abnormal position of the spleen at the mid-abdomen, pelvis or more rarely at the right iliac fossa. ![]() Doppler sonography can be useful to evaluate the blood flow in the parenchyma and in the splenic vessels. The echotexture can be normal, heterogeneous or hypoechoic if complete infarction. US can demonstrate the absence of splenic tissue in its normal position. Plain abdominal radiography findings include the absence of splenic silhouette in the splenic fossa, small bowel loops occupying the left upper quadrant, elevation of the left kidney and a well-circumscribed abdominal mass. Imaging plays a major role in establishing the diagnosis. The clinical presentation of wandering spleen is highly variable, ranging from asymptomatic patients to recurrent episodes of abdominal pain and acute abdomen due to complete torsion and splenic infarction. An unusual association with gastric and pancreatic volvulus have been described. Both congenital and acquired conditions result in a mobile spleen with predisposition to torsion. Acquired anomalies, such as splenomegaly, weakness of the abdominal wall, multiple pregnancies and hormonal changes, have been associated with this entity, explaining its higher incidence among women of reproductive age. The absence of the splenorenal ligament makes the pancreas not completely retroperitoneal, with its tail localized within the splenic hilum. These ligaments hold the spleen in its normal position and attach it to adjacent viscera. The congenital hypothesis is an anomalous development of the dorsal mesogastrium, which does not fuse with the posterior peritoneum, leading to the absence or abnormal development of one or more of the gastrosplenic, splenorenal and phrenocolic ligaments. īoth congenital and acquired causes of wandering spleen have been previously described. ![]() This anomaly is characterized by an abnormal localization of the spleen within the abdominal and pelvic cavity due to hyperlaxity, underdevelopment or even absence of splenic suspensory ligaments. It has two peaks of incidence in children aged less than 10 years and in women of childbearing age. Wandering spleen is a rare condition accounting for less than 0.2% of splenectomies. ![]()
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