Wandering spleen: An unsuspected presentation at a general hospital in Uganda

Abstract

Introduction and importance: Wandering spleen is an uncommon condition marked by splenic hypermobility due to laxity or underdevelopment of the supporting splenic ligaments. Patients may be asymptomatic, have a palpable mass in the abdomen, or exhibit acute, long-lasting, or sporadic symptoms as a result of the spleen's pedicle torsion. The management should be determined by the spleen's vitality.

Case presentation: We report a case of a 29-year-old male who presented with a 5-year history of progressive abdominal swelling, surgically managed as an intrabdominal tumor at a general hospital in Uganda, with a postoperative confirmation of a wandering spleen.

Clinical discussion: Wandering spleen is a rare condition both in high- and low-income countries. Clinical presentations vary from an asymptomatic abdominal mass to acute abdominal pain due to vascular pedicle torsion leading to splenic infarction. When possible, splenopexy is the procedure of choice, especially in children and in tropical countries, to avoid post-splenectomy sepsis. Splenectomy is the definitive treatment for spleen fracture, spleen infarction, or symptoms that recur after splenopexy.

Conclusion: Wandering spleen is a rare differential diagnosis of intrabdominal tumor that must be considered in patients with a palpable abdominal mass with or without acute or chronic abdominal pain. Though a CT scan is the best method to confirm the diagnosis, the radiologist's and surgeon's experience and keenness seem very vital in making the correct diagnosis. Intraoperative complete abdominal exploration by the surgeon is essential to confirm the radiological findings, to enhance the diagnosis, and to make the best treatment decision.

Keywords: CT scan; Case report; Intrabdominal tumor; Low-income setting; Wandering spleen.