Fact-sheet: Wandering spleen
Updated on 04/23/2019 at 10:00 AM
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Definition
Splenic ectopia, or wandering spleen, is defined as migration of the spleen into any quadrant of the abdomen (depending on the weight of the spleen and the length of its pedicle).
It results from a congenital or acquired abnormality of its fixation mechanisms (gastrosplenic and splenorenal ligaments).
This rare entity can be observed at any age in both sexes, but occurs more frequently in children under 10 years of age and in women of reproductive age.
It accounts for less than 0.5% of splenectomies.
Clinical features
Asymptomatic, incidental finding.
Or intermittent abdominal pain reflecting episodes of torsion/detorsion.
In cases of chronic volvulus, the splenic pedicle is twisted, and the artery and vein are compressed. The patient may then develop splenomegaly, hypersplenism, and splenic infarction, causing acute then chronic pain.
Clinical picture of acute surgical abdomen with nausea, vomiting, and fever.
Laboratory findings
Signs of hypersplenism:
- thrombocytopenia
- global leukopenia (sometimes neutropenia)
- often mild anemia
- sometimes hemodilution
Ultrasound
Empty splenic fossa.
"Mass" with the same echostructure as the spleen.
Absence of flow on Doppler suggests torsion.
CT
Empty splenic fossa. Abdominal mass without contrast enhancement after injection, showing the characteristics of the spleen.
Whirl sign of the twisted pedicle.
Splenic infarction.
Management
Splenopexy or splenectomy.
