Experience in the Treatment of Two Cases of Wandering Spleen That Required Additional Gastropexy After Splenopexy

Abstract

The coexistence of wandering spleen and gastric volvulus is well known; however, it is unclear whether these conditions can be treated only by splenopexy. We experienced treating two cases of wandering spleen requiring additional gastropexy after splenopexy by the retroperitoneal pouch method. [Case 1] A 3-year-old girl showed agenesis of the splenocolonic ligament and splenorenal ligament along with stretching of the gastrosplenic ligament. The organoaxial gastric volvulus was released, and splenopexy was performed. Anorexia remained, and abdominal X-ray showed a dilated gastric bubble, so gastropexy was additionally performed on post-operative day 43. [Case 2] A 9-year-old boy showed agenesis of all four ligaments and his spleen was fixed by splenopexy. Hiccups and abdominal pain remained; assuming that insufficient gastric volvulus and spontaneous reduction recurred, gastropexy was additionally performed 337 days after the initial operation. In the two cases, performing only splenopexy of the wandering spleen did not resolve the complaints of the patients because the loose organoaxial gastric volvulus remained. Abnormality of the gastrosplenic ligament is recognized as a key substrate of gastric volvulus after the splenopexy. In the treatment of wandering spleen, simultaneous gastropexy seems desirable.