Torsion of the wandering spleen as an abdominal emergency: a case report

Abstract

Background: Wandering spleen is a rare clinical entity with a less than 0.2% reporting incidence rate. In this case, the spleen is present abnormally in the abdominal or pelvic cavity instead of its normal anatomical location. The aetiology is either congenital or acquired. The condition is caused by the absence or maldevelopment of the spleen's suspensory ligaments, which holds the spleen static in the left hypochondrium.

Case presentation: A 27-year-old female patient presented to the emergency department with complaints of abdominal pain, fever, nausea, vomiting, and constipation for three days. A palpable movable mass was found during the physical examination, and torsion of the wandering spleen's pedicle was confirmed by CT scan. Open splenectomy was performed, and the patient was recovered uneventfully.

Conclusion: Even though ectopic spleen is a rare disease, clinicians should be aware of its incidence. Early diagnosis in the case of an acute abdomen is vital for the preservation of the spleen. Patients presented with acute abdomen and absence of splenic shadow under left hemidiaphragm should be suspected, and further radiological investigation will confirm the diagnosis. Surgery is the gold standard for wandering spleen with either splenopexy or splenectomy, depending on the spleen's condition during surgery.

Keywords: Acute abdomen; Case report; Pelvic spleen; Splenectomy; Wandering spleen.

Fig.1

A coronal CT section showing empty left hemidiaphragm distended small and large bowel, misplaced non enhanced mildly enlarge spleen in the right lower abdomen extending into the pelvis, resting above the urinary bladder and bright capsule (rim sign) of the surface adjacent to the bladder

Fig.2

An axial section of the CT scan showing a "whirl sign" (pathognomonic for pedicle torsion) of the splenic pedicle

Fig.3

Intraoperative photograph of the mildly enlarged, congested and ischemic spleen after splenectomy

Fig.4

Torsion of the prolonged splenic pedicle just before splenectomy

Fig.5

Thrombosis of the splenic vessels, right after cutting the pedicle of the spleen during splenectomy