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Wandering Spleen Volvulus: A Case Report and Literature Review of This Diagnostic Challenge

Challenging differential diagnosis, Rare disease

Evangelos Koliakos, Xenofon Papazarkadas, Marwan-Julien Sleiman, Ioannis Rotas, Michel Christodoulou

Switzerland Department of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland

Am J Case Rep 2020; 21:e925301

DOI: 10.12659/AJCR.925301

Available online: 2020-07-22

Published: 2020-09-01


#925301

BACKGROUND: Wandering spleen is a rare condition in which the spleen lacks the usual peritoneal attachments, resulting in increased intra-abdominal mobility. Complications can occur due to the torsion of the splenic vascular pedicle, resulting in symptoms ranging from an incidental finding to an acute abdomen as a result of an ischemic necrosis of the spleen.
CASE REPORT: We present the case of a 25-year-old female patient who presented with a recurring abdominal pain associated with serum lipase and C-reactive protein elevation. The computed tomography scan revealed torsion of the splenic pedicle and hypoperfusion of the spleen. A surgical exploration was performed and a wandering spleen was diagnosed perioperatively. It was characterized by the lack of peritoneal ligaments, thus resulting in a splenic volvulus. A splenectomy was carried out due to the definite ischemic necrosis of the spleen.
CONCLUSIONS: The diagnosis of this rare condition can be very challenging since it can be presented with a vast variety of symptoms, mimicking other abdominal pathologies. The intermittent nature of an ultimate splenic torsion can add to the diagnostic challenge. Medical literature concerning the wandering spleen and knowledge about this pathology originates mainly from individual case reports. Despite the evolving diagnostic modalities available, this rare and ambiguous disorder remains misdiagnosed, and a high index of suspicion is needed for the appropriate diagnosis to be established.

Keywords: Abdominal Pain, Splenectomy, Splenic Infarction, wandering spleen



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