Recurrent abdominal pain with thrombocytosis

Abstract

Splenic congenital anomalies are many. Wandering spleen (WS) is a rare anomaly account for about 0.2%. It is usually associated with absent or maldevelopment of one or all splenic ligaments that hold the spleen in its place. A 15-year-old girl had complaints of repeated attacks of mid-abdominal pain for the last month. Abdominal examination revealed a central fixed and slightly tender abdominal mass in the umbilical region. Complete blood count revealed platelets (790 × 103/mL), white blood cells (9700 × 103/mL), and hemoglobin (8 g/dL), and other investigations were normal, but unfortunately ultrasound and computed tomography report revealed WS. Abdominal exploration revealed the spleen not in the anatomical place, and there is a mass in the umbilical region surrounded by dense adhesions. The adhesions were released and this mass discovered to be WS, splenectomy was done. Vaccination against pneumococci and Haemophilus influenza were given, and the patient discharged uneventfully on the fourth postoperative day. Asymptomatic WS could be found incidentally during surgery or during abdominal imaging for any reason. Furthermore, WS can present with an acute abdomen or recurrent abdominal pain. The only treatment is surgery even in asymptomatic cases because of the high possibility of complications. Splenopexy can be done if the spleen showed no torsion or splenomegaly or hypersplenism otherwise splenectomy is the second option.