Wandering spleen with gastric volvulus and intestinal non-rotation in an adult male patient

Abstract

We report an extremely rare case of wandering spleen (WS) complicated with gastric volvulus and intestinal non-rotation in a male adult. A 22-year-old man who had been previously treated for Wilson disease was admitted with severe abdominal pain. Radiological findings showed WS in the midline of the pelvic area. The stomach was mesenteroaxially twisted and intestinal non-rotation was observed. Radiology results did not show any evidence of splenic or gastrointestinal (GI) infarction. Elective emergency laparoscopy confirmed WS and intestinal non-rotation; however, gastric volvulus was not observed. It was suspected that the stomach had untwisted when gastric and laparoscopic tubes were inserted. Surgery is strongly recommended for WS because of the high risk of serious complications; however, some asymptomatic adult patients are still treated conservatively, such as the patient in this study. The present case is reported with reference to the literature.

Keywords: Abdomen/GI; CT; adults and pediatrics; congenital; connective tissue disorders; mesentery.

Fig. 1.

Plain abdominal radiography. A pre-laparoscopic image. An enlarged stomach is observed in the left lower abdomen. The upper third of the stomach appears beak shaped in a superior direction (short white arrow).

Fig. 2.

Coronal view of a contrast-enhanced computed tomographic image of the abdomen. (a) The spleen (Sp) is positioned in the midline of the pelvic area. The splenic parenchyma appears homogeneous. The ascending colon (AC) has shifted under the left diaphragm. The small intestine (Sm) appears in the right lower abdominal cavity. The stomach is twisted mesenteroaxially, with the antrum (An) positioned higher than the fundus (Fu). The white arrow heads show the connection from the shifted pylorus to the duodenum. (b) A slice obtained further posterior in the same series as (a). The white arrows show the connection from the shifted fundus of the stomach (Fu) to the cardia (Ca) and esophagus (Eso). The lower inferior vena cava (IVC) runs to the left of the aorta. (c) The schema of the wandering spleen, gastric volvulus, and intestinal malrotation in the presented case. AC, ascending colon; An, antrum of stomach; Ca, cardia; Duo, duodenum; Eso, esophagus; Fu, fundus of stomach; Py, pylorus; Sm, small intestine; Sp, spleen.