Splenic torsion with partial colonic obstruction caused by a wandering spleen in a teenager: A case report

Introduction: The wandering or ectopic spleen is a rare condition, reported only in a few case reports and small case series involving children. In wandering spleen, the spleen migrates from its normal anatomic location to another site of the abdomen due to laxity or underdeveloped supporting ligaments. The severity of clinical manifestation depends upon the degree of torsion and varies from intermittent pain to severe pain in infarction. Case Report: This report presents a case of a young teen with chronic abdominal pain with initial work up that was unremarkable. The diagnosis remained elusive for two years and symptoms persisted. However, due to a recent increase in severity of the abdominal pain and its associated changes in bowel habit that a whole abdomen computed tomography was requested and revealed wandering spleen located in the subhepatic area at the right upper quadrant. The patient underwent diagnostic laparoscopy converted to an exploratory laparotomy with splenic detorsion, splenopexy, and colopexy. The postoperative course was unremarkable. Conclusion: A wandering spleen is difficult to diagnose clinically as the signs and symptoms are usually mild. This patient had initially sought consult to multiple physicians and even a sonography revealed unremarkable findings hence the diagnosis remained elusive for a long time. Torsion and infarction usually occur if left untreated with high mortality rate. Along with evolving diagnostic modalities, a high index suspicion is needed to establish the proper diagnosis. This report highlights the investigation and management of the case.