Torsion of the wandering spleen with intestinal obstruction.

Abstract

Wandering spleen is a relatively rare condition and may be complicated by intestinal obstruction or abnormal intestinal rotation. Herein, we report a case where these three conditions appeared concomitantly. An 18-year-old woman with an intellectual disability was admitted to the hospital because of vomiting and fever. The patient's abdomen was distended. Computed tomography revealed a dilated small intestine, a swollen spleen located in the lower abdomen, as well as twisting and swirling of the splenic artery and vein. The patient was diagnosed with torsion of the wandering spleen and emergency surgery was performed. The vascular pedicle was found to be rotated 900° clockwise, and a markedly enlarged spleen was observed in the lower abdomen. When the splenic torsion was released, the pulsation of the splenic artery was well palpated, suggesting that the spleen could be preserved. Additionally, the sigmoid colon to the cecum was not fixed to the retroperitoneum. Dilatation of the small intestine was observed, but there were no findings of intestinal tract necrosis. Splenic torsion is part of the differential diagnosis for acute abdomen. Familiarity with embryology and anatomy is necessary to select the appropriate surgical technique.