A case of conservatively managed pelvic wandering spleen clinically mimicking uterine mass: A case report and literature review

Abstract

A wandering spleen is a rare clinical condition characterized by abnormal spleen mobility to the abdominal or pelvic cavity from its normal position in the left hypochondrium. Currently the gold standard of management is the surgical option with splenopexy. A conservative approach is another option for management, even though it is not preferable, as most cases eventually complicate. We presented a 26-year-old female patient who had an on-and-off-type abdominal pain of 2 years duration with an 18-week-sized palpable lower abdominal mass. Abdominopelvic ultrasound and CT scan confirmed pelvic wandering spleen. She declined the surgical option and opted for conservative management. Pelvic location with enlargement of the spleen may clinically mimic a uterine mass. There is potential for successful conservative management of pelvic wandering spleen, especially in the absence of acute complications.

Keywords: Conservative; Pelvic spleen; Splenopexy; Wandering spleen.

Fig. 1

(A) The ultrasound representative image shows enlarged lobulated spleen (black star) without focal lesion which is in the lower abdomen adjacent to pelvic organs of bladder (blue star) and uterus(arrow). (B) Color Doppler demonstrates vasculatures of the splenic hilum and absent torsion.

Fig. 2

Coronal abdominopelvic CT: The spleen is not visualized in the left upper quadrant.

Fig. 3

(A-C) Multiphasic multiplanar abdominopelvic CT in portal venous (A and B) and arterial phases (C): (A) shows 14.4 cm measuring solid homogeneously enhancing spleen in the pelvic cavity compressing the urinary bladder (UB). On (B), the uterus (black arrow) is seen closely abutting the spleen (Sp). The typical zebra pattern of enhancement of the spleen (Sp) is clearly depicted on (C).