Abstract Background: Wandering spleen (WS) is a rare clinical entity caused by the mobility of the spleen due to ligament laxity. Wandering spleen with torsion, especially in toddlers, is infrequent and rarely reported. Clinical Description: An 18-month-old boy presented with an acute onset of abdominal pain, nonbilious vomiting, and signs of dehydration. Physical examination was difficult, revealing tenderness in the left iliac fossa. However, no mass was palpable. The patient was admitted with a provisional diagnosis of acute gastroenteritis. The next day, the patient developed bilious vomiting. Management and Outcome: Ultrasound scan showed a cyst in the left iliac fossa. A computed tomography scan of the abdomen suggested an ectopic spleen with signs of torsion. Emergency laparoscopy revealed a large ischemic WS with 720° torsion. Despite laparoscopic detorsion, the spleen remained ischemic. After counseling the parents, a laparoscopic splenectomy was performed. The postoperative period was uneventful. The patient was discharged with penicillin prophylaxis and postsplenectomy vaccination. Histopathology of the specimen confirmed it as splenic tissue with multiple infarcts and a subcapsular abscess. The child remained well and asymptomatic throughout till 1-year follow-up. Conclusion: Wandering spleen with torsion is a rare but significant cause of acute abdomen in toddlers, requiring a high index of suspicion for diagnosis. Surgical management is tailored to the viability of the spleen. Laparoscopic management is challenging but feasible in toddlers.
Bharathi et al. (Wed,) studied this question.