Wandering spleen

Q: You have been called to ER to evaluate a 38 years old female  with fever, abdominal pain, vomiting, dehydration and hypotension. Physical exam shows pain in left lower quadrant with palpable mass. Patient feels relief of pain as you move mass towards left upper quadrant! What you should wonder?

Answer: Wandering spleen

In wandering spleen, the spleen can be found in any part of the abdomen or pelvis because of the length of its pedicle. In acquired form it is due to laxity of ligaments particularly due to multiple pregnancies in child bearing age women.

The abnormally fixed spleen can twist on its vascular pedicle, creating ischemia that may progress to infarction and may presents as an acute abdomen.

It may presents as a triad of

• a firm ovoid mass with a notched edge
• painful movement of the mass except when the mass is moved toward the left upper quadrant 
• resonance to percussion in the left upper quadrant

Treatment is operative.

#GI

#surgical-critical-care

References:

1. Reisner DC, Burgan CM. Wandering Spleen: An Overview. Curr Probl Diagn Radiol. 2018 Jan-Feb;47(1):68-70. doi: 10.1067/j.cpradiol.2017.02.007. Epub 2017 Feb 16. PMID: 28385371.

2. Soleimani M, Mehrabi A, Kashfi A, Fonouni H, Büchler MW, Kraus TW. Surgical treatment of patients with wandering spleen: report of six cases with a review of the literature. Surg Today. 2007;37(3):261-9. doi: 10.1007/s00595-006-3389-0. Epub 2007 Mar 9. PMID: 17342372.