Splenic torsion requiring splenectomy six years following laparoscopic Nissen fundoplication

Abstract

Background: Laparoscopic Nissen fundoplication has become a mainstay in the surgical treatment of gastroesophageal reflux disease, as it has proved to be a durable, well-tolerated procedure. Despite the safety and efficacy associated with this procedure, surgeons performing this advanced laparoscopic surgery should be well versed in the potential intraoperative and postoperative complications.

Methods: A case is presented of a rare complication of splenic torsion following laparoscopic Nissen fundoplication. Diagnostic evaluations and intraoperative findings are discussed.

Results: We present an otherwise healthy 41-year-old woman who underwent a laparoscopic Nissen fundoplication 6 years earlier at another medical center and presented with worsening chronic left upper quadrant abdominal pain. She was diagnosed with torsion of the splenic vascular pedicle, resulting in heterogenicity of perfusion with associated hematoma requiring open splenectomy.

Conclusion: Surgeons should be aware of splenic torsion as a potential, albeit rare, complication related to laparoscopic Nissen fundoplication.

Figure 1.

Reformatted coronal view, CT scan of the abdomen pelvis. Note the nonanatomic location of the spleen in the left lower quadrant and mild heterogenicity of flow noted at the cephalad portion.

Figure 2.

Axial view, CT scan of the abdomen. Note the nonanatomic position and clockwise rotation of the spleen. The white arrow denotes the characteristic whirl sign, pathognomonic for torsion of the vascular pedicle.

Figure 3.

Delivery of the spleen into the wound with splenic rupture noted at the inferior pole.

Figure 4.

On delivery of the spleen, the vascular pedicle was de-torsed, and the spleen immediately decongested. A small amount of hemoperitoneum was noted immediately upon entering the abdomen.