torsion of wandering spleen, an unusual cause of acute abdomen; a report of two cases

Abstract

Background: Wandering spleen is an uncommon entity that is rarely considered in the evaluation of patients with acute abdominal conditions. Objective: To report two cases of wandering spleen presenting with acute abdominal pain. Methods: The clinical records of the patients including preoperative evaluation, intra-operative findings and postoperative care were reviewed Result: A 6-year-old boy presented with right lumbar pain which worsened over a 36-hour period with findings of a tender right lumbar mass. Abdominal ultrasound showed a mass with echogenicity consistent with that of the spleen with no blood flow and an empty splenic bed. T h e pre-operative diagnosis was torsion of a wandering spleen. The second case was that of a 42-year-old woman who presented with severe colicky lower abdominal pain which worsened over three days with a background history of progressively increasing lower abdominal mass which was tender and about 26-week gestational size at presentation. The initial diagnosis was torsion of an ovarian cyst. Abdominal-pelvic Ultrasound scan showed a heterogeneously hypo-echoic mass overlying the uterus and the left ovary with no blood flow. The presence of wandering spleen with torsion of the vascular pedicle was confirmed at laparotomy in both instances. Splenectomy was performed in both cases with good recovery. Conclusion: Torsion of a wandering spleen poses a diagnostic challenge. A high level of suspicion is required to make a diagnosis and institute appropriate treatment.