Torted Wondering Spleen

Abstract

Background: Wandering spleen was first mentioned by Van Horne in 1667. Wandering spleen (floating, ectopic, ptotic, hypermobile or splenoptosis) may float anchored only by its vascular pedicle with no hooking to the nearby structuresand it is induced by the lengthening of the spleen’s holding ligaments. Although it is rare (less than 0.2%) but it affects mostly children and female adults of active reproductive age. It features as a mass in the abdomen without clinical signs or with intermittent abdominal discomfort due to torsion and spontaneous detorsion of the spleen. Case Report: A 34-year-old male presented to the emergency department with complaints of abdominal pain, distension of the abdomen and vomiting with constipation for two days. There was no past history of any surgery. On general examination, patient was afebrile (temperature of 37°c), pulse rate of 80 bpm and blood pressure of 110/70 mmHg. An abdominal examination revealed mild abdominal distension with mild diffuse abdominal tenderness and guarding. A tender lump sizing 10 × 9 cm with smooth surface, well defined margins and firm consistency was found. Digital rectal examination was normal. Laboratory parameters showed hemoglobin 14.5 gm/dl and white blood cells 12000/mm3. The platelet count was normal. Ultrasonography (USG) showed a solid mass and the absence of the spleen from its normal location. A computed tomography (CT) scan of the abdomen showed large torted spleen at mid abdomen with partial or no enhancement of splenic shape mass on contrast-enhanced CT scan and the patient was scheduled for an exploratory laparotomy for surgical acute abdomen. During laparotomy, a mass measuring 11 × 9 × 3 cm and weighing approximately 280 g was found. The mass was identified as the spleen by visualizing its notch and the absence of the spleen from its normal position. All splenic ligamentous attachments were completely absent. The spleen was found to be partly infarcted due to twisting of the spleen .....