Successful non-operative management of an Achilles fracture

Abstract

pedicle. The condition is associated with other congenital abnormalities including the prune-belly syndrome, in which dilatation of the genitourinary tract interferes with gut rotation and fusion of the dorsal mesogastrium7. Some have suggested that it is the abnormal laxity of the splenic ligaments that is the primary aetiology8. An excess incidence in child-bearing years and in the multiparous has raised the possibility of ligamentous lengthening as a cause. Increased splenic mass has also been proposed as a possible aetiology but data regarding malarial and lymphomatous splenomegaly are conflicting; in most patients with a wandering spleen there is nothing wrong with the spleen itself9. Many patients with a wandering spleen are symptomfree, the condition being discovered incidentally on abdominal examination. Intermittent abdominal pains are a common mode of presentationl. Severe and persistent abdominal pain suggests splenic torsion which may vary from 90 to 160 degrees. Delay in diagnosis risks not only splenic infarction but also pancreatic necrosis10. How should a symptomatic wandering spleen be managed? At one time the favoured treatment was splenectomy, but this operation is now avoided when possible because of the spleen's important role in the reticuloendothelial system; therefore there is renewed interest in splenopexy. Torsion of the spleen and consequent infarction still necessitates splenectomy. All patients undergoing elective splenopexy should undergo pneumococcal vaccination in case the need for splenectomy should arise during splenopexy. Of the splenopexy techniques describedll, suturing of the spleen is said not to be complicated by haemorrhage though some feel this applies only to paediatric splenopexy where a thicker splenic capsule is more forgiving12. Our approach, whereby a Prolene pouch is fashioned and secured in the left upper quadrant, is novel. The spleen can then be easily placed within and the pouch closed thus securing the spleen in its correct anatomical position.