International Journal of Studentsí Research

: 2013  |  Volume : 3  |  Issue : 2  |  Page : 57--58

A case of wandering spleen

Suman Sahu1, Suryapratap Singh2, Kanika Sharma3, Piyush Kalakoti1,  
1 Lal Bahadur Shastri Hospital, New Delhi, India
2 Department of Neurosurgery, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India
3 Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India

Correspondence Address:
Suryapratap Singh
Department of Neurosurgery, Narayana Medical College & Hospital, Nellore, Andhra Pradesh


Wandering spleen is a rare entity characterized by huge spleen with laxity of the splenic ligaments, absence of peritoneal attachments and presence of long pedicles. We herein present a case of a 42-year-old female with wandering spleen that presented to our clinic with intermittent abdominal pain associated with an abdominal lump.

How to cite this article:
Sahu S, Singh S, Sharma K, Kalakoti P. A case of wandering spleen.Int J Stud Res 2013;3:57-58

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Sahu S, Singh S, Sharma K, Kalakoti P. A case of wandering spleen. Int J Stud Res [serial online] 2013 [cited 2020 Jan 23 ];3:57-58
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A 42-year-old woman presented to our clinic with 4 months history of an abdominal lump and vague discomfort, intermittent abdominal pain with fullness of abdomen. She reported the pain to have increased in frequency since last 2 weeks. She had a normal body built, was afebrile and with stable vitals. Abdominal examination elicited diffuse tenderness and an intra-abdominal lump spanning over the epigastrium, umbilical, hypogastrium, left hypochondrium, left lumbar, left iliac, and the right iliac region [Figure 1]a]. Routine hemogram, liver and kidney functions, serum electrolytes, urine microscopy, and chest roentgenogram were all normal. Ultrasound of the abdomen demonstrated massive splenic enlargement extending from the epigastrium to hypogastrium on the left to the iliac region on the right. Patient was hospitalized, and initial conservative treatment was initiated. Following 4 h of admission, her abdominal pain became severe and made her restless. A decision on performing an emergency exploratory laparotomy was undertaken in view of her condition following high-risk consent. Intra-operatively, a massive, mobile spleen measuring 25 × 14 × 6.5 cm and with long pedicle and long ligaments was localized extending from the left upper abdomen to the left pelvic region [Figure 1]b]. A splenectomy was performed [Figure 1]c], and the massive organ weighed 3750 g [Figure 1]d]. Histopathological study of the specimen revealed normal splenic tissue. Postoperatively, patient received broad spectrum antibiotics and supportive care. To prevent overwhelming postsplenectomy sepsis, patient was vaccinated with polyvalent pneumococcal vaccine, quadrivalent meningococcal/diphtheria hemophilus b conjugate [1] . With the postoperative period being uneventful, patient was discharged on the 11 th day following surgery. Patient was followed-up once in every 3 months for a period of 1 year and is doing well with no clinical complications.

Wandering spleen, also known as ectopic, displaced, devious or aberrant spleen, is a rare entity defined as a huge, single spleen in an abdominal position rather than its anatomical site owing to laxity of its pedicles and absence of ligamentous attachments [2],[3] . Even though exact etiology is unknown, abdominal laxity, multiparity, irregular menses, hormonal effects of pregnancy, embryologic developmental errors are postulated to be possible causes for laxity of splenic ligaments [4] . While clinical presentation may pose dilemma to the surgeons as it could be mistaken with other abdominal lumps, ultrasonography, tomographic scans and scintigraphy are the most accurate diagnostic tests for wandering spleen [5] . In our case, a provisional diagnosis of splenomegaly was made prior to surgery, and the case was confirmed intra-operatively as a wandering spleen due to the presence of long, vascular splenic pedicle without any peritoneal attachments. It is critical to understand the complications related to wandering spleen specially those arising due to its length of the pedicle. The abnormally fixed spleen can twist on its vascular pedicle predisposing to ischemia that may progress to infarction if not promptly treated surgically [6] . Postoperative management including antibiotics, usually cephalosporins/penicillins and vaccinations to prevent life-threatening infections along with regular follow-ups are utmost essential for these patients.{Figure 1}


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