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).
What is the diagnosis?
Splenic volvulus due to wandering spleen.
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].