Author(s): Anuraj Appukuttan1, Georgeena Elsa Jose2, Arun Puthrukkara3
Wandering or ectopic spleen is a spleen, which is situated outside its normal location with fewer than 500 cases reported in the literature. The incidence of torsion in a wandering spleen is estimated to be less than 0.2%.1 Torsion of a wandering spleen is an important rare differential diagnosis, while dealing with an acute abdomen, if overlooked may result in high mortality.2 Surgical resection of the infarcted spleen produces prompt recovery, but preoperative diagnosis in emergency situations is very challenging despite of modern imaging techniques.3 Herein, we report a rare case where the diagnosis of acute torsion of a wandering spleen was clinched preoperatively, managed successfully and uneventfully.
A 29-year-old nulliparous lady presented to the emergency department with an acute onset left-sided abdominal pain and vomiting for few hours duration. Pain was severe and continuous over the left lumbar and periumbilical area. She had 4 episodes of non-bloody and non-bilious vomiting. She gave no history of any trauma or fall prior to this episode. No significant past medical or surgical history. Physical examination revealed an obese lady (body mass index - 26.1) who was febrile (99.8°F), slightly dehydrated and anaemic with a blood pressure of 110/70 mmHg and pulse rate of 96 beats per minute. Clinical examination revealed a nondistended abdomen with diffuse tenderness and guarding along with a large firm, tender, reniform mass palpable in the left lumbar region measuring around 7 x 10 cm in size, able to get above and below and with restricted mobility. The mass was dull on percussion. Review of other systems were unremarkable.