Massively Enlarged Wandering Spleen With Torsion and Infarction in a 10-Year-Old: Case Report and Comprehensive Literature Review

Abstract

Introduction: Wandering spleen (WS) is a rare condition characterized by abnormal splenic mobility due to congenital absence or acquired laxity of its suspensory ligaments. It is more prevalent in children and women of childbearing age and may present asymptomatically or with acute abdominal symptoms due to splenic torsion, which can lead to infarction or rupture. Presentation of Case: We report a case of a 10-year-old female who presented with a 4-day history of persistent nonbilious vomiting, generalized abdominal pain, and fever. Physical examination revealed a rigid abdomen with tenderness and guarding in the right iliac fossa. Abdominal ultrasound demonstrated an ectopic, enlarged spleen (19 cm) in the lower abdomen, with absent blood flow on Doppler imaging. A contrast-enhanced computed tomography (CT) confirmed splenic torsion, showing the spleen in the mid-abdomen with twisted vascular pedicle and hypoperfusion. The patient underwent urgent splenectomy due to ischemic changes and infarction. Postoperatively, she recovered uneventfully and remained stable during follow-up. Discussion: WS may be congenital, due to incomplete fusion of the dorsal mesentery, or acquired, associated with factors such as pregnancy or chronic splenomegaly. Splenic torsion is the most severe complication, requiring prompt intervention. Imaging modalities such as Doppler ultrasound and CT are critical for diagnosis. Splenopexy is the treatment of choice for viable spleens, whereas splenectomy is necessary for infarcted spleens. Conclusion: WS is a rare, clinically challenging diagnosis requiring high suspicion. Early imaging and surgical intervention are essential to prevent life-threatening complications.

Keywords: case report; pediatric surgery; splenectomy; splenic torsion; wandering spleen.

Figure 1

Abdomen CT with IV contrast in multiple planes, demonstrated: Absent spleen in the left upper quadrant; (a, e, f) massive enlarged spleen in the mid and lower abdomen (blue arrow); (b, e) hypodense heterogenous areas at the parenchyma of the spleen (red arrow) representing hypoperfusion, (d, e) whirled appearance of splenic vessels (yellow arrow); (c) pelvic free fluid (white arrow).

Figure 2

The image depicts an intraoperative finding of a wandering spleen. The spleen is visibly-enlarged and displaced from its normal anatomical position, with clear evidence of torsion at its vascular pedicle. The twisted pedicle suggests compromised vascular flow, which is consistent with splenic torsion. The surgical field is well-exposed, showcasing the extent of ischemic changes likely necessitating splenectomy to prevent further complications.