Splenectomy vs. splenopexy and analysis of wandering spleen management across age groups: a case report

Wandering spleen is a rare clinical entity characterized by abnormal splenic mobility due to ligamentous laxity or absence, with an estimated incidence below 0.2%. This condition poses diagnostic and therapeutic challenges, as it ranges from asymptomatic presentations to acute abdomen secondary to torsion or infarction.

An 83-year-old woman with chronic obstructive pulmonary disease, hypothyroidism, and coronary artery disease presented with 5 days of progressive abdominal pain, vomiting, and distension. Examination revealed a 10 × 10 cm left upper quadrant mass. Computed tomography confirmed an ectopic spleen causing small bowel obstruction. Exploratory laparotomy with splenectomy was performed, revealing a 10 × 12 cm mobile spleen with intact vasculature. Postoperative recovery was uneventful, highlighting the efficacy of surgical intervention in elderly patients.

Wandering spleen's pathogenesis involves congenital (embryonic ligamentous maldevelopment) or acquired (pregnancy, connective tissue disorders) mechanisms. Complications like torsion (reported in 65% of untreated cases) may lead to infarction, rupture, or pancreatitis. While splenopexy is preferred for splenic preservation, splenectomy remains indicated in older patients or vascular compromise, as in our case. Literature review of 10 cases (ages 3-83 years) demonstrates age-dependent management: pediatric cases favor splenopexy, whereas adults more often undergo splenectomy.

Timely imaging and surgical intervention are critical in wandering spleen management. Individualized approaches-prioritizing splenopexy in young patients and splenectomy in elderly or high-risk cases-optimize outcomes. Standardization of surgical techniques and long-term follow-up data are needed to refine treatment protocols.