Splenic Infarct Due to Wandering Spleen in an Adult Patient

We present the case of an eighteen years old woman with the maturational disorder who went to the emergency area because of abdominal pain, focused on the left iliac fossa, fever and vomiting, since four days ago. The blood test showed 15.000 leukocytes, with 81% of neutrophils and PCR, 154. On the physical exploration, a mass on the left quadrant was noticed and positive peritonism signs. The imaging diagnosis consisted of an abdominal X-ray that displayed a lack of sign on the left quadrant and displacement of the bowel luminogram (Figure 1a). Due to these findings, the patient underwent an ultrasound scan, identifying a big and low left positioned spleen, which leads us to complete a CT scan with intravenous iodinated contrast. The CT scan confirmed splenomegaly of 15.6 cm and a wrong localization of the spleen at the left iliac fossa. Not only the spleen showed a low enhancement over more than the 60 percent, (figures 1b and 1c) which correlated with splenic infarct; but wheel sign on the splenic hilus that indicated completed torsion, too (Figure 1d). These findings were in connection with splenic infarct due to twisted hilus in a wandering spleen context. The woman underwent a casualty surgery by laparotomy which confirmed the whole torsion of the splenic vascular pedicle, including the pancreatic tail, and the massive splenic infarct (Figure 1e). Despite the detorsion of the splenic vascular hilus, total splenectomy could not be avoided. After a fair postoperative evolution, the patient was discharged by adding vaccination recommendations against encapsulated germs, through the acquired cell immunodeficiency due to splenectomy.