Twisted wandering spleen

Abstract

The twisted wandering spleen is a rare cause of acute abdomen in the childhood. It is characterized for an absence or hiperlaxity of the splenic ligaments, with the risk to twisting and necrosis. The object of the present article is to report and to discuss the options of treatment of two cases of twisted wandering spleen treated in the Departament of Pediatric Surgery at San Borja Arriarán Hospital. Both patients were diagnosed as acute apendicitis and went into abdominal surgery, the diagnosis could not be confirmed. After surgery, they did not show a clinical improvement , and a left abdominal mass associated to abdominal pain was observed. Ultrasound and CT scan revealed the presence of a mass compatible with a twisted spleen in the mesohypogastric region, and a contorted vascular pedicle twisted on its axis. A second laparotomy was performed and the infarcted spleen was removed in both patients. Although wandering spleen is a rare clinical entity, the possibility of torsion should be kept in mind in the differential diagnosis of acute abdomen.