Torsion of a Wandering Spleen Presenting as a Case of Acute Abdomen

Abstract

Wandering spleen is a rare clinical entity characterized by anomalous position of the spleen in the abdomen due to impaired splenic ligamentous attachments that produce an elongation of the vascular pedicle, favouring a possible volvulus of partial or complete vascular axis. Wandering spleen was first described in autopsies by Johannes Van Horne in 1667. Wandering spleen mainly presents as an asymptomatic mass or seldomly presents as recurrent abdominal pain or acute abdomen. The absence of splenic parenchyma in the left upper quadrant and ectopic location of the spleen can be shown by USG, CT and MRI The procedure of choice in the treatment of wandering spleen is splenopexy. Here we present a case of torsion in a wandering spleen in a 32 years old female. Wandering spleen is a rare clinical entity characterized by anomalous position of the spleen in the abdomen due to impaired splenic ligamentous attachments that produce an elongation of the vascular pedicle, favouring a possible volvulus of partial or complete vascular axis.1 Its aetiology is not clear. Congenital factors exist such as an alteration in the development of the dorsal mesogastrium2 and acquired factors such as hormonal changes during pregnancy,3 abdominal wall weakness, splenomegaly. Clinical presentation is variable, from asymptomatic to chronic abdominal pain or acute abdomen. The most common complication is acute torsion of the splenic pedicle causing acute abdominal pain.