Abdominal Pain Unveiled: Torsion of a Wandering Spleen in a Background of Biliary Stenting

Wandering spleen (WS) is a rare clinical entity caused by congenital or acquired laxity of the splenic ligaments, resulting in abnormal splenic mobility. This condition often remains undiagnosed due to nonspecific symptoms but may lead to life-threatening complications such as torsion and infarction. We report a case of a 23-year-old male with a history of extrahepatic portal vein obstruction and biliary stenting, who presented with acute abdominal pain. Imaging revealed an enlarged spleen with associated ischemic changes. The spleen had migrated to the right iliac fossa, forming a palpable lower abdominal mass. Intraoperatively, dense adhesions and splenic infarction were observed, necessitating a total splenectomy. This case highlights the diagnostic challenges associated with WS, particularly in patients with complex hepatobiliary histories. Early imaging, especially CT, is crucial for diagnosis. Prompt surgical management tailored to splenic viability, splenopexy for a viable spleen, or splenectomy in cases of infarction is essential to prevent severe outcomes. Clinicians should maintain a high index of suspicion for WS in patients presenting with recurrent, unexplained abdominal symptoms.