Torsion of a wandering spleen with preserved vascular supply

Introduction: Wandering spleen is a rare clinical entity caused by congenital or acquired laxity, elongation, or absence of the splenic ligaments, allowing the spleen to migrate from its usual anatomical position. The most serious complication is torsion of the splenic vascular pedicle, which can lead to infarction, peritonitis, and, if not promptly treated, death. Case Presentation: We report the case of a 2-year-old female with a history of intermittent abdominal pain and a recent finding of a mobile infraumbilical mass. She was referred with a presumptive diagnosis of an abdominal tumor. Abdominal ultrasound revealed an ectopic spleen with torsion of the vascular pedicle. Despite the torsion, splenic vascularization was preserved. Management and Outcome: Emergency laparotomy was performed. Intraoperatively, a 720-degree torsion of the splenic pedicle was identified. Manual detorsion was performed, and splenopexy was achieved. The postoperative course was uneventful. Conclusion: This case underscores the importance of early diagnosis and prompt surgical intervention in patients with torsion of a wandering spleen. Ultrasound with Doppler imaging is an effective first-line diagnostic tool. When the spleen is viable, splenopexy remains the treatment of choice in pediatric patients.