Wandering spleen: a surgical enigma

Abstract

Wandering spleen, also referred to as ‘ptotic spleen’, is a rare clinical condition characterized by splenic migration form its normal left hypochondrial position to any other abdominal or pelvic position. Among the multifactorial etiologies proposed, laxity of the spleen’s primary supporting ligaments is the most agreed-upon hypothesis. We present one rare case of wandering spleen in an 11-year-old girl who presented with recurrent abdominal pain with no localizing features. Her abdominal examination revealed an intra-abdominal left iliac fossa lump with restricted mobility, which was confirmed as a wandering spleen by abdominal sonography and contrast-enhanced computed tomography. Intraoperatively, an infarcted spleen was encountered with tortuous, elongated, torsional splenic pedicle and a single dense adhesive band with descending colon. Splenectomy was offered to the patient. Post-operatively, the patient is healthy and symptom free at one-year follow-up. The rare clinical diagnosis of this condition, particularly in the paediatric age-group, makes it an enigma for the surgical world.

You wander… you lose! Importance of surgical intervention in wandering spleen

“…Noninvasive methods includes ultrasonography, CT with contrast and magnetic resonance imaging scan . Doppler ultrasonography and contrast CT scan are able to provide additional information on the blood flow to the splenic pedicle, which is useful when there is a suspicion of torsion . As in our case, this diagnosis was confirmed after performing a CT scan.…”

“…The dorsal mesogastrium gives rise to ligaments that holds the spleen in place. Any failure or defects to the normal development of the splenic ligaments results in this abnormality . The main ligaments known to be involved are the splenorenal and gastrosplenic ligaments .…”

“…The main ligaments known to be involved are the splenorenal and gastrosplenic ligaments . For women in childbearing age, this condition is attributed to the acquired laxity of the ligaments due to hormonal changes and abdominal laxity as a result of multiple pregnancies …”

“…The clinical presentation of a wandering spleen can be variable. Patients can be asymptomatic with incidental finding on examination or imaging . They can also present with recurrent intermittent abdominal pain due to repeated torsion and spontaneous detorsion of the splenic pedicle, or an acute abdomen where there is a torsion of the splenic pedicle leading to an infarction…”

“…Early surgical intervention is required after diagnosis of a wandering spleen. There is a 65% risk of torsion and subsequently splenic infarct if fixation of the spleen is not performed . If the splenic pedicle has not been compromised, splenopexy is treatment of choice to spare the removal of the spleen .…”