Acute torsion of wandering spleen: MRI findings

Wandering spleen: A rare entity and a diagnostic dilemma

Wandering spleen refers to a spleen that is ectopic in its location contrary to a normal spleen which rests in the left hypochondrium. Although it is a rare clinical entity seen in children, it can also be rarely seen in females of reproductive age group. We present one such case of wandering spleen which was misdiagnosed earlier as a sub-hepatic collection.

Torsion of Wandering Spleen and its adherence to the right ovary - An unusual cause of recurrent pain abdomen

Wandering spleen is a rare condition in which the spleen is hypermobile due to laxity or lack of its supporting ligaments. It can be located anywhere in the abdomen besides its usual position. The other terms that are used to describe this condition are splenic ptosis, displaced spleen, dislocated spleen and ectopic spleen. Splenic torsion is a dreaded complication and the usual cause of symptoms. There is a high chance of missing the diagnosis as it remains asymptomatic or may be incidentally discovered on radio-imaging done for a different purpose. An acute abdomen is the most common presentation. Here we describe an unusual case presenting with torsion of the wandering spleen that was adherent to the right ovary.

Wandering Spleen: A Rare Diagnosis with Variable Presentation

We present two cases of wandering spleen, one in a 47-year-old woman who presented with constipation, and one in a 3-year-old girl who presented with acute abdominal pain. Wandering spleen is a rare clinical condition characterized by ectopic positioning of the spleen due to abnormal peritoneal attachments including the lienorenal and gastrosplenic ligaments. The spleen can “wander” or migrate into various positions within the abdomen or pelvis due to this ligamentous laxity. The clinical presentation of patients with this entity is variable and can range from an incidental finding to an acute abdomen associated with torsion. Various imaging modalities can be utilized for the diagnosis of this condition.

Tale of a wandering spleen: 1800 degree torsion with infarcted spleen and secondary involvement of liver

Wandering spleen is a rare clinical entity characterized by splenic hypermobility resulting from laxity or maldevelopment of the suspensory splenic ligaments. The spleen can "wander" or migrate into various positions within the abdomen or pelvis due to this ligamentous laxity. It is usually detected between 20 and 40 years of age, and is more common in women. The clinical presentation of a wandering spleen is variable, it could present as an asymptomatic, incidentally detected, abdominal or pelvic mass, or as an acute abdomen secondary to splenic torsion. Diagnosis in an emergent setting can be challenging as it is a rare cause of acute abdomen and does not produce any symptoms until splenic torsion has occurred. We present and discuss a case of ectopic, torsed spleen resulting in complete infarction of the spleen and severe hepatic vascular compromise, diagnosed by ultrasound, confirmed by computed tomography and effectively managed by splenectomy.

Wandering spleen in an adult man associated with the horseshoe kidney

INTRODUCTION

A wandering spleen occurs when there is a laxity of the ligaments that fix the spleen in its normal anatomical position.

CASE PRESENTATION

This is a case report of a wandering spleen with horseshoe kidney in a 29-year-old male admitted with acute lower abdominal pain and vomiting to emergency department of Shariati hospital in Isfahan province. Sonographic examination showed a homogeneous 21 × 15 × 8 cm mass in the lower part of the abdomen and pelvis associated with a horseshoe kidney. Laparotomy confirmed the clinical and ultrasound findings.

CONCLUSIONS

The association of horseshoe kidney with a wandering spleen in this case may be due to an embryological anomaly.

Congenital anomalies of the spleen

Various congenital anomalies may affect the spleen, starting with common anomalies, such as an accessory spleen, up to rare conditions such as a wandering spleen and polysplenia. Most of these anatomic variants have no clinical significance; they need, however, to be recognized by the radiologist as such. Awareness of these variants is important for the radiologist to interpret the findings correctly and avoid mistaking them for a clinically significant abnormality. In this review we illustrate the spectrum of congenital anomalies of the spleen and stress pitfalls and possible complications resulting from these anomalies.