Wandering spleen presenting as a pelvic mass: A rare case report and literature review

Abstract

Wandering spleen is a rare condition caused by the absence or laxity of the ligaments that normally hold the spleen in place, resulting in its abnormal mobility within the abdominal or pelvic cavity. We report the case of a 15-year-old girl who presented with acute abdominal pain and nonspecific clinical findings. Abdominal CT revealed an enlarged ectopic spleen in the pelvic region with a long, tortuous vascular pedicle, but no signs of torsion or infarction. This case highlights the variable clinical presentation of wandering spleen, which can range from incidental discovery to acute abdomen, with imaging particularly CT being crucial for diagnosis. In uncomplicated cases, splenopexy is preferred to preserve splenic function, whereas splenectomy is reserved for infarcted or nonviable spleens. The case underscores the importance of considering wandering spleen in adolescents with unexplained abdominal pain and demonstrates how early diagnosis and conservative surgical management can prevent serious complications.

Keywords: Acute abdominal pain; Ectopic spleen; Pelvic mass; Splenectomy; Splenopexy; Vascular pedicle; Wandering spleen.

Fig. 1

Axial (A) and (B) reformatted CT scan images of the abdomen post IV contrast administration, showing an ectopic spleen (white arrows) in the pelvic region.

Fig. 2

Contrast-enhanced axial and sagittal CT images of the upper abdomen showing the absence of splenic tissue in the left upper quadrant, with an enlarged ectopic spleen located in the pelvic region and a mild delay in homogenization during the portal phase.

Fig. 3

Post-IV abdominal CT images: venous phase (A-C) and arterial phase (D) showing an ectopic spleen located in the pelvic region. A long tortuous vascular pedicle containing the splenic vessels (C, white arrows: whirl sign) is seen extending from the epigastric region to the prolapsed spleen. There was a long splenic pedicle containing tortuous vessels with the splenic vein and artery. Sagittal contrast enhanced CT image showing a large ectopic spleen in the pelvis suspended by an elongated and tortuous vascular pedicle.