Acute Abdominal Pain in Pregnancy Revealing a Wandering Spleen With Infarction: A Case Report

Wandering spleen (WS) is a rare condition caused by the absence or laxity of splenic suspensory ligaments, predisposing the spleen to displacement and potential complications. While torsion is the most commonly reported issue, infarction due to vascular compromise is a serious and rare complication, particularly in pregnancy. We present a case of splenic infarction in a WS during pregnancy, emphasizing diagnostic challenges and management strategies.

A 19-year-old primigravida at 5 months of gestation presented with progressively worsening abdominal pain and a palpable right-sided abdominal mass. Ultrasound and magnetic resonance imaging (MRI), chosen for its safety in pregnancy, confirmed an enlarged, ectopic spleen with infarction and splenic vein thrombosis. Conservative management with anticoagulation and supportive therapy was initially attempted but failed due to worsening pain and clinical deterioration. Surgical intervention was deemed necessary, and a splenectomy was performed. The patient recovered well postoperatively, with fetal well-being maintained throughout.

Diagnosing WS in pregnancy is challenging due to nonspecific symptoms and limited imaging options. MRI plays a pivotal role in identifying ectopic spleen and assessing vascular compromise. Although torsion is commonly associated with infarction, infarction can occur through other mechanisms such as venous thrombosis or outflow obstruction. Early recognition and timely surgical intervention are essential to reduce maternal and fetal morbidity.

WS in pregnancy presents a diagnostic and therapeutic challenge, with infarction posing a significant but underreported risk. MRI is a valuable tool in pregnant patients, allowing safe and accurate diagnosis. A multidisciplinary approach and individualized treatment strategies are essential for optimizing both maternal and fetal outcomes.