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Keywords:

  • Gastroenterology;
  • general surgery;
  • hepatology

Key Clinical Message

  1. Top of page
  2. Key Clinical Message
  3. Synopsis
  4. Question
  5. Diagnosis
  6. Explanation
  7. References

We describe the case of a wandering spleen complicated by volvulus and demonstrate the role of radiology and urgent intervention in managing this rare but potentially fatal condition.


Synopsis

  1. Top of page
  2. Key Clinical Message
  3. Synopsis
  4. Question
  5. Diagnosis
  6. Explanation
  7. References

A 41-year old woman presented with epigastric pain. On examination, there was generalized abdominal tenderness but no peritonism. Routine blood investigations were normal. Plain abdominal and erect chest X-rays were unremarkable. CT of the abdomen was requested (Fig. 1).

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Figure 1. CT showing the abnormal location of an infarcted spleen within the pelvis.

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Explanation

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  2. Key Clinical Message
  3. Synopsis
  4. Question
  5. Diagnosis
  6. Explanation
  7. References

Failure of development or laxity in the lienogastric, lienorenal and phrenicocolic ligaments can result in a hypermobile spleen attached only by an elongated vascular pedicle [1, 2]. This allows the spleen to migrate to any part of the abdomen or pelvis. Other causes may include splenomegaly, trauma and pregnancy [1-3]. Clinical presentation ranges from an incidental finding to abdominal catastrophe. Torsion with subsequent venous occlusion leads to splenic infarction. Computerized tomography will allow visualization of the spleen and location of the pancreas (Fig. 2). Laparoscopy with distortion maneuvers and splenopexia may be possible if diagnosis and intervention are performed early (Fig. 3), however, splenectomy is usually required [1-3].

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Figure 2. CT showing swirling of the vascular pedicle in keeping with splenic volvulus.

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Figure 3. Intraoperative picture taken at laparotomy showing an infarcted spleen and twisted vascular pedicle, in keeping with splenic volvulus.

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References

  1. Top of page
  2. Key Clinical Message
  3. Synopsis
  4. Question
  5. Diagnosis
  6. Explanation
  7. References
  • 1
    Sheflen, J. R., M. L. Chung, and K. A. Kretchmar. 1984. Torsion of the wandering spleen and distal pancreas. Am. J. Roentgenol. 142:100101.
  • 2
    Hiham, E., L. Jihane, and L. Abdellatif. 2010. Torsion of a wandering spleen. Saudi J. Gastroenterol. 16:288291.
  • 3
    Granel, B., J. Serratrice, and J. Bartoli. 2003. Splenic volvulus in a young woman. Am. J. Med. 114:422.