Wandering spleen with pancreatic volvulus and colonic obstruction in an elderly patient

Abstract

Introduction: Wandering spleen is a rare condition, caused by elongation or maldevelopment of splenic ligaments resulting in splenic hypermobility. Very few cases, if any, have been documented in the elderly population. Herein, we report a case of wandering spleen with pancreatic volvulus and colonic obstruction in an 87-year-old female. Case Report: The patient presented with recurrent abdominal pain and distension. Imaging done at admission revealed a wandering spleen in the pelvis, with splenomegaly and enlarged splenic vein. An explorative laparotomy was performed, the spleen was found to be in the pelvis, there was a volvulus of the distal pancreas. The pancreas had adhesion bands across the distal tail and there was one particular band that was going across to the descending colon causing an internal hernia and colonic obstruction. A splenectomy with a distal pancreatectomy and subtotal colectomy was performed. Conclusion: Wondering spleen is most commonly seen in children and adults with a higher incidence in women especially in the childbearing age. The cause can be congenital or acquired. The most common presentation in patients with wandering spleen is abdominal pain with associated genito-urinary complaints. Due to the longstanding history of this patient, it is crucial to consider wandering spleen in differential diagnosis of patients with non-specific abdominal pain. It is very important to diagnose such cases early so as to prevent complications, especially in elderly population, where symptoms and signs may not point towards the condition.