32 Acute Splenic Torsion of Wandering Spleen in Association with Intestinal Nonrotation and Situs Inversus

Abstract Background Wandering spleen is a rare clinical entity, accounting for less than 0.5% of all splenectomies. It results from congenital or acquired laxity or absence of the splenic suspensory ligaments, increasing the risk of torsion and infarction. Symptoms are often vague, making diagnosis challenging. We report a case of acute splenic torsion in a patient with concurrent situs inversus, intestinal nonrotation, and multiple splenic artery aneurysms. To our knowledge, this association has not been previously described. Case Presentation A 42-year-old woman undergoing investigations for infertility and intermittent abdominal pain was found to have situs inversus totalis, intestinal nonrotation, a pelvic wandering spleen, and two 2 cm splenic artery aneurysms. Prophylactic splenectomy was considered but deferred. She presented with acute right iliac fossa pain, a tender palpable mass, and signs of local peritonitis. CT demonstrated a splenic torsion with a ‘whirl sign’ and infarction. Emergency laparotomy confirmed situs inversus and intestinal nonrotation. The spleen was twisted 1440° around a long vascular pedicle with engorgement and infarction. A splenectomy to include the aneurysms and appendicectomy were performed. Postoperative recovery was uneventful. Discussion Wandering spleen and intestinal nonrotation both result from disrupted embryological fixation of the dorsal mesentery. Situs inversus may share embryological basis of visceral orientation. When situs inversus is combined with intestinal nonrotation, anatomical orientation becomes particularly challenging. Conclusions Chronic intermittent splenic torsion should be considered in patients with nonspecific abdominal pain and a mobile spleen. Definitive management with splenectomy or splenopexy should be considered based on individual risk factors and anatomical considerations.