Published online Jul 27, 2021. doi: 10.4254/wjh.v13.i7.774
Peer-review started: February 7, 2021
First decision: May 13, 2021
Revised: May 28, 2021
Accepted: July 2, 2021
Article in press: July 2, 2021
Published online: July 27, 2021
Processing time: 165 Days and 13.5 Hours
The displacement of spleen from its normal location to other places is known as wandering spleen (WS) and is a rare disease. The repeated torsion of WS is due to the presence of long pedicle and absence/laxity of anchoring ligaments. A WS is an extremely rare cause of left-sided portal hypertension (PHT) and severe gastric variceal bleeding. Left-sided PHT usually occurs as a result of splenic vein occlusion caused by splenic torsion, extrinsic compression of the splenic pedicle by enlarged spleen, and splenic vein thrombosis. There is a paucity of data on WS-related PHT, and these data are mostly in the form of case reports. In this review, we have analyzed the data of 20 reported cases of WS-related PHT. The mechanisms of pathogenesis, clinico-demographic profile, and clinical implications are described in this article. The majority of patients were diagnosed in the second to third decade of life (mean age: 26 years), with a strong female preponderance (M:F = 1:9). Eleven of the 20 WS patients with left-sided PHT presented with abdominal pain and mass. In 6 of the 11 patients, varices were detected incidentally on preoperative imaging studies or discovered intraoperatively. Therefore, pre-operative search for varices is required in patients with splenic torsion.
Core Tip: Wandering spleen (WS) is a rare disease. The repeated torsion of WS is due to the presence of long pedicle and absence/laxity of anchoring ligaments.WS is an extremely rare cause of left-sided portal hypertension and severe gastric variceal bleeding. This review comprehensively describes the pathophysiological mechanisms, clinico-demographic profile, and clinical implications of torsion of the spleen. In patients with splenic torsion, varices can be detected incidentally on preoperative imaging studies or intraoperatively. Therefore, pre-operative search for varices is required in patients with splenic torsion.