Elective Robotic Splenectomy for Wandering Spleen-Associated Pancreatitis: A Novel Case Report

Wandering spleen (WS) is a rare congenital anomaly characterized by abnormal mobility of the spleen due to laxity of the splenic suspensory ligaments. WS can result in complications such as torsion, infarction, and involvement of adjacent structures including the pancreas. This report details a unique case of WS complicated by acute pancreatitis due to splenic torsion. A 45-year-old multiparous woman with a history of psoriasis, gastro-esophageal reflux disease, and chronic pain presented with recurrent left upper quadrant abdominal pain and biochemical signs of pancreatitis. Cross-sectional imaging revealed splenomegaly, abnormal spleen positioning, and torsion of the splenic pedicle with a transient elevation in lipase. A multidisciplinary team diagnosed intermittent splenic torsion and detorsion complicated by traction on the pancreatic tail, leading to pancreatitis. Despite the recurrent nature of her symptoms, the patient remained clinically stable, allowing for elective robotic splenectomy. Intraoperatively, the spleen was found in the pelvis. Notably, the tail of the pancreas was also mobile and displaced from its normal location, necessitating a pancreatopexy to anchor and secure the body and tail of the pancreas within the left upper quadrant, thereby restoring normal anatomy and reducing the risk of future displacement. Wandering spleen can be a rare but important cause of recurrent abdominal pain and acute pancreatitis. Timely recognition of its imaging features and complications, such as splenic torsion and pancreatic inflammation, is essential. Elective splenectomy or splenopexy should be considered for patients with preserved splenic function and stable clinical status.