A painful twist: Wandering spleen with torsion and infarction: A case report

Introduction

Wandering spleen is a rare condition characterized by abnormal spleen mobility due to defects in its supporting ligaments. Delayed management can lead to severe complications such as torsion and infarction, making early diagnosis and surgical intervention crucial for preventing adverse outcomes.

Case presentation

A 16-year-old girl presented with recurrent episodes of severe left hypochondrial pain, which worsened over six months, accompanied by occasional vomiting. Physical examination revealed a tender, palpable spleen extending from the left hypochondrium to the left iliac fossa. Imaging studies, including abdominal ultrasound and contrast-enhanced CT scan, revealed an enlarged spleen with signs of pedicle torsion and infarction, confirming a diagnosis of wandering spleen with vascular compromise. An emergency splenectomy was performed, revealing significant splenic enlargement with torsion and infarction, with no ligamentous attachments. The patient recovered uneventfully and received a pneumococcal vaccine along with long-term antibiotic prophylaxis prior to discharge.

Discussion

Wandering spleen often presents with nonspecific symptoms, leading to misdiagnosis or delayed treatment. Diagnostic imaging is essential for accurate identification. Management typically involves surgery, with splenopexy preferred when feasible and splenectomy reserved for cases with complications.

Conclusion

Wandering spleen, though rare, requires prompt recognition and management to prevent complications like torsion and infarction.