骨盤内遊走ひの１例

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  • A Case of a Wandering Spleen in the Pelvic Cavity.

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This paper presents a case of wandering spleen in the pelvic cavity, which is very rare.<br> A 27-year-old woman had irregular menstrual period, was referred to the our hospital by a gynecologist for investigation of a pelvic mass. There was a previous history of wandering a laparotomy for peritonitis due to rupture of the intestine complicated by unbilical hernia just after her birth.<br> After admission, laboratory data indicated slight hypersplenism. On clinical examinations, there was a palpable huge suprapubic mass, which was elastic and soft and was not fixed. CT defined a 12×5cm lesion distinct from the uterus. Angiography showed that the pelvic mass was fed by a large arterial branch, which had no other branches and more encasement than other arteries. Doppler ultrasonography showed one artery and one vein supplying the pelvic mass, and venous doppler wave resembled that of the portal vein. We diagnosed the pelvic mass as a wandering spleen with hypersplenism. We treated the patient with a splenectomy, because she had the history of undergoing the laparotomy, had high blood vessel encasement with anatomical variation such as celiacomesentric type, and had a very narrow space of the upper abdomen. A congenital defect in the suspensory ligaments was concluded to have been the cause of the wandering spleen in this case, and the patient acquired portal hypertension resulting in splenomegaly with enhancement in the spleen function. After the operation, hypersplenism recovered, and she was soon discharged from the hospital. She has had no complications nor complaints as of 2 years after the operation.

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