Ischemic torsion of an ectopic accessory spleen in a young female: Case report and narrative review of the literature

Ischemic torsion of an accessory spleen is a rare and under-recognized cause of acute abdomen, often mimicking more common conditions and contributing to diagnostic delay. We report the case of a 20-year-old female presenting with acute left lower quadrant abdominal pain and no prior medical or surgical history. Laboratory evaluation demonstrated leukocytosis with neutrophilia, while ultrasound revealed a splenic-like mass with absent Doppler flow. Contrast-enhanced CT identified a 50 × 74 × 76 mm non-enhancing, avascular splenic-density lesion distinct from the orthotopic spleen, raising strong suspicion of an ischemic accessory spleen. Urgent laparotomy confirmed torsion of the vascular pedicle, and an accessory splenectomy was performed. The postoperative course was uneventful, and the patient was discharged after 5 days of hospitalization, remaining asymptomatic at follow-up. A focused 15-year narrative review identified approximately 23 comparable cases, reinforcing the rarity of this entity. Most reports involve young patients presenting with non-specific abdominal pain, with CT serving as the most reliable diagnostic tool and surgical excision as treatment of choice. This case supports including ischemic accessory spleen in the differential diagnosis of unexplained acute abdomen in young patients and highlights the value of timely imaging-based recognition.