Laparoscopic gastropexy for the treatment of gastric volvulus associated with wandering spleen.
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.
François-Fiquet
Caroline
C
Department of Pediatric Surgery, American Hospital, Reims, France. caro_mtp@hotmail.com
Belouadah
Mohamed
M
Chauvet
Philippe
P
Lefebvre
Francis
F
Lefort
Gérard
G
Poli-Merol
Marie Laurence
ML
D002675:Child, Preschool; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D013270:Stomach / Q000601:surgery*; D013277:Stomach Volvulus / Q000601:surgery*; D050805:Wandering Spleen / Q000150:complications* / Q000601:surgery