Torsion of wandering spleen in a woman presenting as emergency.

Wandering spleen is a very rare condition, it is characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the left hypochondrium. The disorder is not genetic in origin. Instead of ligaments, the spleen is attached by a stalk-like tissue supplied with blood vessels (vascular pedicle). If the pedicle is twisted in the course of the movement of the spleen, the blood supply may be interrupted or blocked (ischemia) to the point of severe damage to the blood vessels (infarction). Because there is little or nothing to hold it in place the spleen "wanders" in the lower abdomen or pelvis where it may be mistaken for an unidentified abdominal mass. "Acquired" wandering spleen may occur during adulthood due to injuries or other underlying conditions that may weaken the ligaments that hold the spleen in its normal position (e.g., connective tissue disease or pregnancy). We here report a case of 40-year-old woman presented to the surgical emergency department, with complaints of colicky abdominal pain of 8 h duration with increasing severity and bilious vomiting. On examination, the patient well built, nourished, conscious, and coherent with profuse sweating. Vital signs were normal excepting high pulse rate of 120/min with blood pressure of 100/60. On examination, she has a central abdominal distention shifting to different quadrants with colicky pain with vague tender firm mass. Abdominal ultrasonography showed ectopic spleen around the umbilicus with variable echos and whorled appearance of the splenic vessels. The patient was prepared for emergency laparotomy. At laparotomy, the spleen was found just below the umbilicus and it was dusky enlarged with infarction with four anticlockwise twists of the long splenic pedicle in the central quadrant of the abdomen. Splenectomy was carried out as there was clear evidence of splenic ischemia after detorsion of the spleen.