Wandering spleen with torsion causing an acute abdomen: A case report

Introduction and importance: Wandering spleen, also known as ectopic spleen, is an uncommon disorder in which the spleen's anatomical location differs from its fixed position in the abdomen's left upper quadrant. The etiology is either congenital or acquired, possibly leading to torsion and splenic infarction. It affects children and young adults, especially childbearing-age women. Patients affected by this condition may present with nonspecific symptoms requiring a high index of suspicion. Given the nonspecific clinical symptoms and the potential complications associated with wandering spleen, computed tomography scans provide a crucial means for proper diagnosis.

Case presentation: A 38-year-old female patient presented with worsening abdominal pain of one-week duration. The pain was more localized to the left hemi abdomen but later she claimed that it became diffuse. She had associated vomiting of ingested matter and loss of appetite. She had a similar complaint of abdominal pain for the last year. Up on examination, she looked acutely sick. Abdominal examination showed a flat abdomen moved with respiration; a big intra-abdominal mass was tender; it was freely mobile in all directions; with no sign of fluid collection. A CT scan of the abdomen suggested an ectopic spleen with splenic torsion. Intraoperative findings revealed an infarcted wandering spleen. An emergency splenectomy was performed. The patient was discharged on the third postoperative day and had an uneventful postoperative recovery.

Clinical discussion: If a normal spleen is not identified in the left upper quadrant, a search for ectopic splenic tissue should ensue. If the patient has not had a prior surgical splenectomy, some possible explanations include an ectopic or "wandering" spleen. This case was an infarcted wandering spleen caused by abnormal ligamentous attachments.

Conclusion: Wandering spleen with torsion poses a great diagnostic challenge for acute abdomen due to the rarity of its occurrence and non-specific presentations. A high index of suspicion is the key to early diagnosis and timely intervention is required to improve treatment outcomes.