Torsion of a wandering spleen: an uncommon cause of acute abdomen

Résumé

Background: Wandering spleen is a rare clinical entity caused by congenital or acquired laxity or absence of the splenic suspensory ligaments, resulting in excessive splenic mobility and an increased risk of vascular pedicle torsion. This condition may progress to splenic infarction and represent a surgical emergency. Because its clinical presentation is often nonspecific, diagnosis is frequently delayed unless characteristic imaging findings are recognized. In this case report, we highlight the clinical and radiological features suggestive of splenic torsion, with particular emphasis on the diagnostic value of computed tomography and the surgical decision-making process.

Case Presentation: We report on the case of a 15-year-old patient who presented with acute abdominal pain and vomiting. Physical examination revealed diffuse abdominal tenderness associated with a mobile abdominal mass. Laboratory investigations showed elevated inflammatory markers. Contrast-enhanced computed tomography revealed an absent spleen in the left upper quadrant with an ectopic pelvic splenic mass associated with twisting of the vascular pedicle (whirl sign), suggesting splenic torsion. Emergency laparotomy confirmed complete torsion with splenic infarction. Detorsion was attempted; however, due to lack of reperfusion, splenectomy was performed. The postoperative course was uneventful, and the patient was discharged on postoperative day seven.

Conclusion: Torsion of a wandering spleen is an uncommon but potentially life-threatening cause of acute abdomen in children and adolescents. Early recognition and prompt CT imaging are crucial for diagnosis. Surgical management is mandatory, with spleen-preserving procedures recommended whenever splenic viability is maintained.