Laparoscopic gastropexy for the treatment of gastric volvulus associated with wandering spleen

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 19 Suppl 1; p. S137
• Main Authors: François-Fiquet, Caroline, Belouadah, Mohamed, Chauvet, Philippe, Lefebvre, Francis, Lefort, Gérard, Poli-Merol, Marie Laurence
• Format: Journal Article
• Language: English
• Published: United States 01.04.2009
• Subjects: Child, Preschool; Humans; Laparoscopy - methods; Male; Stomach - surgery; Stomach Volvulus - surgery; Wandering Spleen - complications; Wandering Spleen - surgery
• DOI: 10.1089/lap.2008.0091.supp
• ISSN: 1092-6429

A 2.5-year-old boy was referred to the emergency room for a sudden onset of diffuse and increasing abdominal pain with lethargy, abdominal distension, and vomiting, all in the past 24 hours. A plain abdominal X-ray showed gastric distension. Two liters of gastric contents were evacuated by suction. The abdominal sonogram showed an unusual position of the spleen in the left-lower quadrant, with no splenic ischemia. The diagnosis of gastric volvulus associated with a wandering spleen was then evoked. Laparoscopic exploration revealed a nonischemic spleen, absence of normal supporting ligaments for the spleen, and gastric distension with flaccid gastric walls. The spleen was then easily moved in the left-under quadrant. A parietal peritoneal posterolateral incision was made, opposite the large gastric curve, up to the diaphragm (7 cm). This delimitated a sharp demarcation zone between the two edges of the incised peritoneum. The stomach was fixed to the peritoneal incision, covering and anchoring the spleen in a good position. Recovery was uneventful, and an abdominal sonogram performed 4 years after the surgery shows a viable spleen in its correct location. The rarity of gastric volvulus associated with a wandering spleen and its fast clinical improvement with medical treatment often delays the diagnosis and the surgical treatment. Laparoscopy in this case has a dual relevance: diagnosis and therapeutic management (splenectomy or gastropexy). Laparoscopic gastropexy for the treatment of gastric volvulus associated with a wandering spleen is an easy procedure and combines the advantages of all the surgical techniques previously described.