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Case Reports
. 2025 Jun:131:111421.
doi: 10.1016/j.ijscr.2025.111421. Epub 2025 May 9.

A case of torsed wandering spleen presenting as perforated acute appendicitis: A case report and literature review

Ayat Aljuba  1 , Alaa R Al-Ihribat  1 , Bahaa AbuRahmeh  1 , Noor Khashan  1 , Kareem Lbraheem  2 , Yara Al Najajreh  3
Affiliations
Case Reports

A case of torsed wandering spleen presenting as perforated acute appendicitis: A case report and literature review

Ayat Aljuba et al. Int J Surg Case Rep. 2025 Jun.

Abstract

Introduction: Wandering spleen (WS) is a rare circumstance characterized via exaggerated splenic mobility because of absent or lax suspensory ligaments. It predisposes the spleen to torsion, that could purpose infarction, rupture, or gangrene, requiring urgent intervention.

Presentation of case: We report a 10-year-old girl with a three-day history of acute abdominal pain, vomiting, and fever. Physical examination revealed diffuse tenderness, predominantly in the right lower quadrant (RLQ), mimicking appendicitis. Ultrasound and CT showed WS with torsion, showing the characteristic whirl sign. Emergency laparotomy revealed a 720-diploma splenic torsion with necrosis, necessitating splenectomy. The patient had an uneventful recovery and was discharged on postoperative day five.

Discussion: WS is an extraordinary entity (<0.2 % occurrence) with a bimodal age distribution, often affecting adolescents and girls. It can be congenital or acquired and presents variably, from asymptomatic cases to acute abdomen. Torsion leads to vascular compromise, requiring prompt surgical intervention. This case was very interesting to the surgical team for its atypical presentation and its resemblance to perforated appendicitis.

Conclusion: WS must be considered in cases of acute abdomen with an absent spleen on imaging. Early recognition and surgical intervention are essential to prevent complications in patients with acute abdomen. Ultrasound and CT are critical for early detection and differentiation from different abdomen emergencies.

Keywords: Acute abdomen; Pediatric splenectomy; Right lower quadrant pain; Splenic torsion; Wandering spleen.

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Conflict of interest statement

Conflict of interest statement The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
A: Axial contrast-enhanced CT image demonstrates a whorled appearance of the splenic vessels (red arrow), indicative of vascular torsion in a case of wandering spleen. This suggests splenic volvulus, a potential surgical emergency due to the risk of infarction. B: This contrast-enhanced coronal CT scan shows an ectopic spleen displaced into the right lower abdomen/pelvis, indicative of wandering spleen due to the absence or laxity of normal splenic ligamentous attachments. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Intraoperative appearance of twisted splenic 720° counterclockwise around its pedicle and infarcted spleen.
See this image and copyright information in PMC

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