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Wandering spleen presenting as acute pancreatitis in pregnancy
Rachel S Gilman1, Ronald L Thomas
1Department of Obstetrics and Gynecology, Allegheny General Hospital, The West Penn Allegheny Health System, Pittsburgh, Pennsylvania 15212, USA. rgilman@wpahs.org
Background:
Wandering spleen most frequently presents clinically with gastrointestinal bleeding and thrombocytopenia.
Case:
A 24-year-old multiparous patient at 36 weeks' gestation presented with pancreatitis. Incidental thrombocytopenia was discovered. A 2722-g female neonate was delivered by repeat cesarean from a breech presentation. The spleen was observed at the left margin of the incision. An evaluation of the pancreatitis included a computed tomography study demonstrating an enlarged spleen twisted on its pedicle and displaced inferiorly. Esophagogastric duodenoscopy performed in evaluation of gastrointestinal bleeding showed persistent gastric varices. Multiple transfusions were required. A splenectomy was performed. The recovery was uncomplicated.
Conclusion:
In this case of a wandering spleen, pancreatitis resulted from torsion and obstruction of the tail of the pancreas within the splenic pedicle and was effectively treated with splenectomy. Thrombocytopenia occurred as a result of sequestration of platelets in the enlarged spleen. Persistent gastric varices and subsequent gastrointestinal bleeding occurred secondary to splenic vein obstruction.
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