Double Twist and Shout: An Emergency Caused by Torsion of the Ovary and the Wandering Spleen

Intermittent severe abdominal pain is a medical emergency with multiple possible underlying causes. This case report describes a 30-year-old female experiencing severe pelvic pain alternating between the left and right lower abdomen. The pain was periodic and very intense. She also experienced intermittent, vague pain in the upper abdomen. Clinical examination and imaging suggested torsion and detorsion of an ovarian fibroma or dysgerminoma. Additionally, a distended dolichocolon was seen in the upper abdomen. Laparoscopy revealed a twisted and enlarged right ovary in the pelvis. In the upper abdomen, a distended dolichocolon was observed along with a twisted, black spleen. The blood vessels of the wandering spleen hung over the colon like a rubber band, causing constriction. The ovary was removed and diagnosed as a cellular fibroma after histopathological examination. Attempts to untwist the spleen laparoscopically were unsuccessful, so a mini-laparotomy was performed to manually untwist it. Afterward, the spleen regained its normal position and color. Due to the significantly elongated dolichosigmoid, which could cause further complications, the affected segment was removed and a reanastomosis was performed. At the end of the procedure, the spleen remained stable in its original position with a healthy coloration. In retrospect, this patient experienced intermittent twisting of the ovary and spleen over an 18-month period, causing severe abdominal pain. The key lessons from this case are to take abdominal pain seriously, thoroughly examine all areas during surgery, and avoid stopping the investigation after identifying a single issue. A critical approach is essential to pinpointing the cause of each specific symptom, as one pathology may not always explain all observed symptoms. This comprehensive approach ultimately saved the patient's spleen.