Wandering spleen

Introduction to spleen The spleen is separated from the normal anatomical location and is located in other parts of the abdominal cavity, called spleen prolapse or ectopic spleen; the spleen has both prolapse and reduction, and is active or migratory, called floatingspleen. This disease is very rare, women are 3 to 13 times more than men, and more common in middle-aged women. The incidence of postpartum menstruation in middle-aged women is higher. It is reported in the literature that the incidence rate of women is 13 times higher than that of men, and it also occurs in childhood. basic knowledge Sickness ratio: 0.0001% Susceptible population: Women are 3 to 13 times more likely than men, and are more common in middle-aged women. Mode of infection: non-infectious Complications: hypersplenism acute peritonitis spleen rupture

Wandering spleen

Congenital factors (45%):

The normal spleen is maintained in a certain anatomical location due to the spleen and stomach ligament, spleen and colon ligament, spleen and kidney ligament and the support of the spleen and sac ligament and abdominal pressure produced by abdominal muscle tension. For example, there is a defect in the development of the dorsal mesentery in the embryonic stage, which makes the spleen pedicle long, and the above ligament development is abnormal and relaxed, the support capacity is greatly weakened, and the spleen is displaced in the abdominal cavity.

Other factors (25%):

Due to the original lesions of the spleen (such as chronic malaria), it may also be due to spleen prolapse and spleen pedicles have torsion, congestion, the spleen can lead to spleen pedicle torsion, spleen ligament is pulled and lengthened, abdominal trauma or women During the pregnancy, the secretion changes cause abdominal muscle relaxation, and the maternal postpartum abdominal muscle weakness is the predisposing factor for the spleen.

Pathogenesis

The spleen is larger than the normal spleen. This may be due to the original lesion of the spleen. It may also be due to the spleen prolapse and the spleen pedicle is reversed. The result of hyperemia is that the spleen often has greater mobility in the early stage. It can be fixed due to the adhesion of surrounding tissues. About 20% of the spleen can cause the spleen to twist. The reason for the twist is different. The upper part of the spleen is very large. When it is displaced downward, the upper pole is easy to the midline. Tilting, often the beginning of torsion; and the contraction of the abdominal muscles, the peristalsis of the intestines, the change of position, and the change of external force, etc., can all contribute to the factors of torsion, and the speed and degree of reversal can be very different. The resulting lesions are also different: mild torsion or only half a circle (180 °) torsion, the result is more spleen congestion and swelling, and even more may have exudate, bleeding; torsion to 2 to 3 laps Because the spleen pedigree is completely blocked, it can cause complete necrosis of the spleen. The surrounding tissue can also be limited or diffuse peritonitis due to the stimulation of exudate, or form a chronic adhesion around the spleen, such as only arterial obstruction. It can cause spleen atrophy and fibrosis.

Travel spleen prevention

The spleen is mainly caused by the excessive spleen pedicle and relaxation, and actively treats the primary disease such as malaria to prevent secondary lesions. Splenomegaly can also cause the disease, so it should develop good living habits, prevent spleen lesions, and induce the disease. In addition, trauma to the spleen and spleen pedicle damage should be treated as soon as possible to prevent long-term prolonged unhealed, causing concurrent lesions caused by spleen.

Travel spleen complications Complications, hypersplenism, acute peritonitis, spleen rupture

Chronic spleen torsion with splenic venous congestion can cause gastric varices, intermittent torsion can lead to spleen congestion, followed by splenomegaly, hypersplenism, spleen exudate, hemorrhage, necrosis or infection, but also acute intra-abdominal hemorrhage Symptoms of various complications such as acute peritonitis and local abscess, spleen rupture may occur due to trauma or increased intra-abdominal pressure during pregnancy. In some cases, other visceral sag may be combined.

Swollen spleen symptoms common symptoms nausea and abdominal pain, abdominal mass, constipation, suffocation, acute shock

It can vary greatly depending on the pathological changes, but mainly depends on the degree of torsion and torsion of the spleen. The patient may have no obvious symptoms, or the adjacent organs may be involved or the surrounding organs may be oppressed. Symptoms, such as the spleen itself, can produce different manifestations.

Usually, if there is no adhesion around the spleen and the spleen activity is large, the patient may have no obvious symptoms, but it may also have a mass that can move in the abdomen. The severe person may feel discomfort or pain in the left upper abdomen, disappear in bed, stand up When the symptoms are aggravated, the symptoms mainly involve the stomach, which may include nausea and vomiting, swelling and suffocation. The symptoms of compression vary depending on the organ involved: compression of the intestine can cause acute and chronic mechanical obstruction; compression of the pelvis Those who have urgency and weight, poor bowel movements or constipation symptoms; bladder or uterus compression may have dysuria or irregular menstruation.

The speed and degree of spleen twirling have a great influence on the symptoms: acute torsion is caused by sudden position change, trauma, late pregnancy, etc., which can cause severe abdominal pain with nausea, vomiting and other gastrointestinal symptoms, and even shock state, but chronic Incomplete torsion may have no symptoms or only mild abdominal pain.

Check for spleen

The diagnosis of spleen is generally not difficult. If necessary, the following auxiliary examinations can be made:

Type 1B ultrasound, the normal spleen disappeared under the left ankle, and the spleen reflex appeared at the abdominal mass.

2 Nuclide scans, such as the 51Cr mark check, can be found that the abdominal block has isotope accumulation, and see the obvious abdominal block outline.

3 Selective celiac angiography showed that the vascular supply of the mass was from the splenic artery.

4CT examination.

Diagnosis and identification of spleen

Asymptomatic spleen is often found in patients who have undergone physical examination or imaging examination, or because of abdominal masses. In other parts of the abdominal cavity during prolapse, it can be seen in the spleen and has a notched lumps. The voiced area disappears, and when the patient is lying down, the mass can be returned to the spleen. Most patients have been reversed due to dislocation of the spleen. The peritoneum is stimulated by exudate, and the abdominal muscles are stiff and straight, so that the spleen cannot be removed. The shape is difficult to diagnose.

The spleen mainly needs to be differentiated from the left kidney, the pancreas and the gastrointestinal tract, and the lymph node tumor. The main point of identification is to find the lumps, whether there are spleen gate and spleen vascular images, which is different from other abdominal organs. An important feature of the tumor.

When the spleen is located in the lower abdomen or pelvic cavity, if acute complete spleen pedicle torsion occurs, it is easy to be confused with acute volvulus, ovarian cyst torsion and acute cyst perforation, and acute diffuse peritonitis caused by perforation of the appendix.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.