Wandering Spleen: A Rare Diagnosis with Variable Presentation

Abstract

We present two cases of wandering spleen, one in a 47-year-old woman who presented with constipation, and one in a 3-year-old girl who presented with acute abdominal pain. Wandering spleen is a rare clinical condition characterized by ectopic positioning of the spleen due to abnormal peritoneal attachments including the lienorenal and gastrosplenic ligaments. The spleen can “wander” or migrate into various positions within the abdomen or pelvis due to this ligamentous laxity. The clinical presentation of patients with this entity is variable and can range from an incidental finding to an acute abdomen associated with torsion. Various imaging modalities can be utilized for the diagnosis of this condition.

Laparoscopic splenectomy for a wandering spleen causing chronic pelvic pain

“…Unless splenic torsion occurs and acute abdominal clinical symptomatology develops, clinical diagnosis is highly challenging due to lack of symptoms (8). The most common presentation includes subacute abdominal pain with or without other gastrointestinal complaints (9). It may also present with an acute abdomen due to splenic infarction caused by sudden torsion of the splenic pedicle (10).…”

Torsion of wandering spleen

“…Wandering spleen is when the spleen is in an ectopic position due to laxity of the anchoring ligaments. This results in a long splenic pedicle, predisposing the patient to splenic torsion, leading to partial or complete infarction [1].…”

“…The presentation of wandering spleen varies widely from abdominal mass, ranging from intermittent abdominal pain to being asymptomatic, found by incidental imaging [1], [2]. Because it is a rare condition, for the most part, clinical diagnosis is difficult and imaging by ultrasound with Doppler interrogation, CT scan and MRI with intravenous contrast plays a major role in establishing a diagnosis.…”

“…The radiological diagnostic criteria include absence of spleen in the left upper abdomen, lower abdomen, or pelvic mass, whorled appearance of splenic vessels, ascites and necrosis of the pancreatic tail. The whorled appearance of splenic vessels and surrounding fat at the splenic hilum is specific for torsion of wandering spleen [1], [3]. Patients are either treated with splenopexy, which allows anatomical placement of the spleen, or splenectomy, which is performed in splenic torsion with massive infarction and thrombosis of splenic vessels.…”

Wandering spleen: a rare clinical entity

“…1 Wandering spleen is uncommon and results due to congenital mal-development or due to acquired laxity of peritoneal attachments including the lienorenal and gastrosplenic ligaments. 2 Ectopic, migrating or splenoptosis are synonymous with wandering spleen. Spleen can move to the lower abdomen or pelvis.…”