Wandering Spleen: Found with bowels attached

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    Long and twisted splenic pedicle in Wandering Spleen

    According to the basic anatomy of the human body, spleen resides in left hypochondrium. Gastrosplenic and lienorenal ligaments are the two splenic ligaments responsible for fixing spleen in the left hypochondrium. In highly rare circumstances, spleen abandons its location and migrates to an unusual location. This condition usually occurs when the splenic ligaments fail to develop completely. They form a long splenic mesentery. This rare congenital condition is called Wandering Spleen. It is especially common in multiparous women in their active reproductive years. This condition often goes unnoticed in patients. Surprisingly, surgeons mistake it for unidentified and unusual tumor-like mass in the lower abdomen or pelvis.

    Here is a rare case of a 37-years-old woman who had complained of abdominal pain, nausea and constipation. According to her, she suffered from similar episodes every 5-6 months for 4 years. Each time she consulted the local practitioners for relief. She was a mother of 4 children. Her latest delivery was 4 months before the episode of pain and nausea. She had no surgical history.

    Physical examination

    Physical examination presented 99℉, mild pallor, pulse rate of 80 beats-per-minute and 110/70 mmHg blood pressure. She had mild abdominal distension and diffused tenderness. Moreover, a lump of dimensions 13 x 9 cm was palpable. It rested over the periumbilical area with a smooth surface and firm consistency. 
    Digital rectal examination was normal. 
    Blood tests revealed hemoglobin 9.5gm/dl, white blood cell count 10,100/mm3 and normal platelet count.

    Here lies the surprise!

    Ultrasonography (USG) revealed something quite shocking. The spleen was not present where in its location! Where was spleen? This finding surprised the practitioners. Surgeons perfomed laparotomy at once to find out what was wrong.

    Laparotomy revealed a solid mass with dimensions of 12 x 9 x 4 cm. Normal dimensions are 5 x 3 x 1.5. The mass weighed 350 g. Normal weight of spleen is 139 g. To utter disbelief bowels were adhered to this mass. Surgeons identified the solid mass as the spleen. More astonishing was finding out the absence of all splenic ligaments. Moreover, the pedicle of spleen was longer than usual. It twisted around the pedicle. This caused partial infarction in spleen. The splenic pedicle contains splenic vessels. Torsion of splenic vessels causes complete or partial infarction of spleen. 

    Bowel adhered to spleen.

    The patient was diagnosed with Wandering Spleen. 

    Surgical treatment

    In cases of Wandering Spleen, the only treatment is operative. Splenectomy is the most preferred surgical treatment. Splenopexy is a treatment of choice. The priority is to preserve the spleen especially in patients younger than 30 years. They are at risk of post-splenectomy sepsis. In the case of infarction, splenectomy is mandatory. In this case, total splenectomy was the only treatment.

    Multiple infarcted areas in spleen.

    The patient was discharged on 5th post-operative day. Vaccinations against pneumococcal disease, meningococcal disease, and hemophilus influenza were given.

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