Giant ectopic splenic volvulus: a rare surgical emergency

Splenic volvulus is a rare condition most often associated with a wandering spleen (WS) due to congenital or acquired ligamentous laxity. A giant ectopic splenic volvulus in adults without identifiable risk factors is exceptionally rare.

We report the case of a 46-year-old woman with no significant past medical history who presented with acute abdominal pain. Computed tomography (CT) revealed a giant ectopic spleen measuring approximately 20 cm, with torsion of the splenic pedicle, consistent with splenic volvulus. Emergency surgery was performed. Intraoperatively, the spleen was found to be massively enlarged, ectopic, and nonviable due to vascular compromise. A splenectomy was therefore carried out. The postoperative course was uneventful.

This case underscores the diagnostic challenge of giant ectopic splenic volvulus in an atypical patient profile. The extreme size of the spleen likely exacerbated the torsion due to increased gravitational pull on an otherwise normal pedicle. While detorsion and splenopexy are preferred in pediatric or early-presenting cases to preserve immune function, the massive enlargement and established vascular compromise in this adult necessitated emergency splenectomy to prevent necrosis and life-threatening peritonitis. This case adds to the scarce literature on giant WSs in adults, reinforcing that the "whirl sign" on CT is pathognomonic and that delayed intervention invariably leads to splenic infarction.

Giant ectopic splenic volvulus is a rare but potentially life-threatening condition. Early diagnosis based on imaging and prompt surgical management are crucial. Splenectomy remains the treatment of choice when splenic viability cannot be preserved.