A 28-year-old woman presented with a mass in the abdomen. The mass was in fact a wandering spleen that migrated from its normal location!
Wandering spleen, a rare condition with an incidence rate of <0.5%, in which the spleen migrates from its normal anatomical position to, mostly, the lower abdomen or pelvis. Usually, multiparous women between 20-40 years are affected.
Ultrasound and computed tomography scan are helpful in the diagnosis and in identifying the location of the migrated spleen. Moreover, Doppler ultrasound demonstrates the splenic vascular flow to help diagnose splenic torsion or infarction. In the latter case, splenectomy may be necessary. Otherwise, the wandering spleen needs surgical detorsion and splenopexy.
This case describes a 28-year-old multiparous female who presented to the emergency department with a 2-day history of abdominal pain and nausea. Her pain was in the left upper quadrant, mild, and non-radiating. According to the patient, she had similar symptoms 6 months back when she received a diagnosis of acute pancreatitis. However, the aetiology was unidentified, hence, idiopathic pancreatitis. She denied alcohol intake, use of any prescription medicines, herbal supplements, or recreational drugs. Although, she had no documentation regarding those treatments.
Past surgical history was unremarkable.
General physical examination revealed an afebrile female with mild pallor. Her vitals revealed a pulse rate of 84 bpm and blood pressure of 116/80 mmHg. An abdominal examination revealed mild diffuse abdominal tenderness and guarding in the left lower quadrant. Moreover, palpation of the abdomen also revealed a 13 × 9 cm tender lump. The mass had a smooth surface, well-defined margins, and firm consistency. Peristalsis was visible over the periumbilical area. Digital rectal examination was normal.
Serology revealed normal parameters. However, her lipase was elevated.
Abdominal ultrasound showed minimal sludge in the gallbladder, but no stones. A computed tomography scan showed a spleen in the anterior left lower quadrant of the abdomen. Moreover, it also revealed an elongated pancreatic tail coiled with the splenic vessels
Doctors decided to manage her conservatively.
With conservative management, the patient improved substantially. However, once she stabilised, she underwent splenopexy at another facility.