The enigmatic wandering spleen: managing three cases in a tertiary setting

Wandering spleen is a rare clinical entity characterized by abnormal mobility of the spleen due to laxity or absence of its supporting ligaments. In pediatric patients, this condition can present with vague abdominal symptoms or acute torsion leading to infarction, posing a significant diagnostic challenge. Early identification through imaging and timely intervention are crucial to preserve splenic function. Conducted in a tertiary care setting, we report three pediatric cases of wandering spleen, each illustrating a different clinical course and surgical management strategy. The first case involved a 13-year-old girl with progressive abdominal pain and vomiting, ultimately requiring splenectomy after unsuccessful detorsion attempts. The second case featured a 10-year-old girl with a previously known pelvic spleen who underwent successful laparotomy and splenopexy upon finding a partially viable spleen. The third case involved a 3-year-old girl with fever, acute pain, and imaging evidence of an ectopic spleen; intraoperative detorsion and splenopexy preserved splenic tissue, underscoring the importance of salvage when possible. These cases highlight the variable presentation of wandering spleen, the pivotal role of imaging in diagnosis, and underscore that splenic salvage should be prioritized whenever feasible to maintain immunologic function. Splenopexy remains the preferred option for viable spleens, while splenectomy is reserved for nonviable organs, with adequate follow-up essential to monitor for potential postoperative complications.