Splenectomy for wandering splenomegaly in a patient with idiopathic thrombocytopenic purpura: A case report of a rare association.

Abstract

Wandering spleen (WS) is an uncommon congenital or acquired condition resulting from the absence or abnormal development of the spleen ligaments causing its outside position. WS has life-threatening complications ranging from torsion of the vascular pedicle to spleen infarction. In this paper, we report the use of open splenectomy in a female with an idiopathic thrombocytopenic purpura history with WS. We report a case of a 23-year-old nulliparous female with idiopathic thrombocytopenic purpura. After complaining of chronic abdominal pain in the lower abdomen, the patient underwent an abdominopelvic ultrasound which showed a spleen of a pelvic seat at the size of 180 mm with homogeneous echo-structure and a free left spleen compartment. A complimentary computed tomography scan revealed ectopic splenomegaly (about 194 ∗ 62 ∗ 150 mm) in the pelvis with normal enhancement and no signs of infarction or torsion. A splenectomy was indicated due to the large spleen size and the patient's medical history. The postoperative course was uneventful. After the operation, an increase in the platelet count was registered, requiring aspirin administration to avoid thrombosis. WS diagnosis should be considered whenever acute or chronic abdominal pain is associated with mobile abdominal or pelvic mass. Recognition of this disease is mandatory, and surgical management should not be delayed. • The absence or malformations of splenic suspensory ligaments attaching the spleen to the diaphragm, colon, and retroperitoneum is the major cause of wandering spleen (WS). • Diagnosis is often an occasional finding during radiological exams. • Conservative treatment may lead to high complications. Thus, surgery with organopexy is the standard gold treatment. However, the preserving treatment is debatable in WS associated with idiopathic thrombocytopenic purpura.