CASE 10038 Published on 07.05.2012

Wandering spleen with torsion: a case report

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

Arifuzzaman M, Reeta Rani, Naveed Ahmed, Hanif Khatri, Tariq Mahmood

JPMC, Jinnah Post Graduate Medical Center,
Department of Radiology;
Rafeeqi road
76650 Karachi, Pakistan;
Email:m_arif1976@hotmail.com
Patient

35 years, female

Categories
Area of Interest Spleen, Abdomen ; Imaging Technique CT
Clinical History
A 35-year-old female patient was admitted with complaints of acute abdominal pain for 36 hours. She has experienced similar episodes of pain during the past year. Her medical history was insignificant. Physical examination revealed a giant mass in right abdominal quadrant and generalised abdominal tenderness.
Imaging Findings
Combined abdominal sonography and contrast enhanced CT examination demonstrated the absence of spleen in its normal position. A 16.5x14.5x10 cm (TSxAPxCC) mass extends below the liver up to the pelvis in the right abdomen, consistent with wandering spleen. No contrast enhancement within the splenic parenchyma is seen. Medial to the pedicle of the spleen is a whorl-like appearance which shows splenic artery in its centre and small bowel loops twisting around it. There is also associated thrombus seen in the splenic vein, superior mesenteric vein and the portal vein.
Discussion
Wandering spleen is characterised by a congenital deficiency or acquired laxity of splenic suspensor ligaments. It is a rare clinical entity that accounts for less than 0.25% of all indication for splenectomy [1]. Wandering spleen is also known as splenoptosis, ectopic spleen, free floating spleen, pelvic spleen or aberrant spleen. The spleen is anchored in its normal position by several ligaments. In wandering spleen, gastrosplenic, splenorenal and other suspensor ligament of spleen are absent congenitally or have laxity subsequent to pregnancy, hormones or injuries. Therefore the wandering spleen is found most commonly in women of reproductive age group [2]. It may also occur in children who constitute one third of all cases [3]. The torsion usually occurs clockwise and is precipitated by body and adjacent organ movements and subsequent changes in intraabdominal pressure [4]. The probability of torsion is high if the diameter of spleen is big and the vascular pedicle is long. With torsion of spleen venous returns impairs, congestion and capsular stretching occurs. This may lead to venous thrombosis. Arterial supply of spleen is compromised with oedema and congestion. This leads to infarction, fibrosis and necrosis of spleen [3]. Complications of acute splenic torsion are gangrene, abscess formation, necrosis of pancreatic tail and bleeding gastric varicose veins [5]. Pancreatic tail infarction may be due to stretch in splenic pedicle after torsion and congestion of wandering spleen. Imaging has a very important role in the diagnosis of wandering spleen. USG and CT of the abdomen are the most useful diagnostic methods.
Differential Diagnosis List
Wandering spleen with torsion
Mesenteric cyst with small bowel volvulus
Ovarain torsion
Final Diagnosis
Wandering spleen with torsion
Case information
URL: https://www.eurorad.org/case/10038
DOI: 10.1594/EURORAD/CASE.10038
ISSN: 1563-4086