Wandering spleen: a surgical enigma

Area of Science:

• Pediatric Surgery
• Abdominal Imaging
• Gastroenterology

Background:

• Wandering spleen (ptotic spleen) is a rare condition involving splenic migration from its normal anatomical location.
• The most accepted etiology involves laxity of the spleen's supporting ligaments, leading to increased mobility.

Observation:

• An 11-year-old girl presented with recurrent, non-specific abdominal pain.
• Physical examination revealed a palpable, mobile lump in the left iliac fossa.
• Abdominal sonography and contrast-enhanced computed tomography confirmed the diagnosis of wandering spleen.

Findings:

• Intraoperative findings included an infarcted spleen with a tortuous, elongated, and torsional splenic pedicle.
• A dense adhesive band was noted between the spleen and the descending colon.
• Splenectomy was performed due to splenic infarction.

Implications:

• This case underscores the diagnostic challenge of wandering spleen, especially in pediatric patients presenting with vague abdominal pain.
• Successful surgical management (splenectomy) resulted in complete symptom resolution and a positive one-year follow-up.
• Highlights the importance of considering rare diagnoses in pediatric abdominal pain.