Ectopic spleen: An easily identifiable but commonly undiagnosed entity until manifestation of complications

Abstract

Introduction: Ectopic spleen is an uncommon clinical entity as splenectomy for treatment of ectopic spleens accounts for less than 0.25% of splenectomies. The most common age of presentation is childhood especially under 1 year of age followed by the third decade of life.

Presentation of case: The present report refers to a patient with torsion of a pelvic spleen treated with splenectomy. The patient exhibited a period of vague intermittent lower abdominal pain lasted 65 days followed by a period of constant left lower quadrant pain of increasing severity lasted 6 days. On the first 65 days, vague pain was attributed to progressive torsion of the spleen which resulted in venous congestion. On the last 6 days, exacerbation of pain was attributed to irreducible torsion, infraction of the arterial supply, acute ischemia, strangulation and rupture of the gangrenous spleen. Diagnosis was made by CT which revealed absence of the spleen in its normal position, a homogeneous pelvic mass with no contrast enhancement, free blood in the peritoneal cavity, and confirmed by laparotomy.

Discussion: Clinical manifestations of ectopic spleen vary from asymptomatic to abdominal emergency. Symptoms are most commonly attributed to complications related to torsion. Operative management, including splenopexy or splenectomy, is the treatment of choice in uncomplicated and complicated cases because conservative treatment of an asymptomatic ectopic spleen is associated with a complication rate of 65%.

Conclusion: Although an ectopic spleen can be easily identified on clinical examination, it is commonly misdiagnosed until the manifestation of complications in adulthood.

Keywords: Ectopic spleen; Rupture; Strangulation; Torsion; Wandering spleen.

Fig. 1

A free-floating spleen, attached only to its abnormally elongated vascular pedicle, was discovered among loops of small intestine and sigmoid colon within the pelvis. The spleen was enlarged, congested, strangulated and ruptured at its lower pole.

Fig. 2

Strangulation of the spleen occurred due to a 760° clockwise torsion of its vascular pedicle.

Fig. 3

The spleen continued to appear non-viable despite the counterclockwise derotation.