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A Case of Small Intestinal Ileus Due to Wandering Spleen with a Large Cyst

Takehisa Matsuyama, Toshimasa Nakao, Shumpei Harada, Tsukasa Nakamura, Shuji Nobori, Hidetaka Ushigome

(Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto City, Kyoto, Japan)

Am J Case Rep 2019; 20:1138-1140

DOI: 10.12659/AJCR.916845

BACKGROUND: Splenic cysts are rare. Most are due to previous trauma, infection, or infarction. They are generally handled by laparoscopic surgical removal if they are larger than 5 cm. However, very large cysts may require splenectomy. Another factor in the choice of therapy is the patient’s underlying condition. We present the case of a giant splenic cyst in a woman 1 year after a renal transplant.
CASE REPORT: A 28-year-old woman presented with acute abdominal pain and nausea. One year before, she had received an ABO-identical living donor renal transplantation from her father, and was maintained on oral tacrolimus and prednisolone. A CT scan with contrast showed enteric ileus and an abnormal position of the spleen, which was involved by a cyst measuring 12×12.5×9 cm. A nasogastric tube, and later a small bowel tube, were inserted to decompress the ileus. The patient underwent laparotomy 11 days after admission. We confirmed an internal hernia with volvulus due to migration of the spleen; however, there was no evidence of necrosis. The patient was treated with splenectomy and reduction of the hernia. There were no complications.
CONCLUSIONS: This was a very unusual emergency following renal transplantation. Splenectomy has been performed in the past for immunosuppression in cases of donor ABO-incompatibility. We therefore considered that it would be more expedient to remove the spleen than to remove the cyst and perform splenopexy.

Keywords: Hernia, Ileus, Intestinal Volvulus, Spleen

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