Pancreatic volvulus with wandering spleen and gastric volvulus: an unusual triad for acute abdomen in a surgical emergency

Abstract

Wandering spleen is a rare clinical condition which occurs due to laxity or absence of the normal intraperitoneal ligaments that hold the spleen in place. Gastric volvulus and wandering spleen share a common etiology of absence or laxity of intraperitoneal ligaments. The occurrence of simultaneous pancreatic volvulus has never been described before in adolescence. Herein, we report a case having wandering spleen with torsion, and gastric and distal pancreatic volvulus, an unusual triad in acute abdomen in an emergency setting, which has never been described before to the best of our knowledge.

Figure 1

(a) Axial multiplanar reformatted (MPR) image showing spleen with heterogeneous attenuation lying on the right side of abdomen (black arrow) and pancreas (white arrow) located between the stomach and spleen. (b) Coronal MPR image showing the twist involving the splenic vessels (white arrow) as well as distal pancreas (black arrow). Also seen is grossly distended stomach in both (a) and (b)

Figure 2

(a) Coronal and (b) axial MPR images showing grossly distended stomach with the pyloroduodenal junction lying higher up (white arrow in a) and anterior (white arrow in b) to the gastroesophageal junction (black arrow in b). Ryles tube is seen entering into the stomach in (a)

Figure 3

(a) Intraoperative photographs. The wandering spleen is seen on the right side of the abdomen (black arrow in a) with associated twisted distal pancreas (thick white arrow in a) and splenic hilum (thin white arrow in a). (b) Decompressed rotated stomach (black arrows is b) is seen with pyloroduodenal junction anterior (thick white arrow in b) to the gastroesophageal junction (thin white arrow in b)