The spleen is an organ normally situated in the upper left quadrant of the abdomen, shielded by the lower ribcage. It serves as a filtering center for the blood, removing old or damaged red blood cells, storing blood components, and housing specialized white blood cells that fight infection. Wandering spleen, also known as ectopic or pelvic spleen, is a rare medical condition where the organ is no longer anchored in its typical anatomical location. This hypermobility allows the spleen to migrate to other areas of the abdomen or pelvis. This abnormal positioning results from the anatomical structures meant to hold it in place being either absent or severely weakened.
Defining the Condition and Its Cause
The spleen is typically held stationary against the posterior abdominal wall by several peritoneal attachments, notably the gastrosplenic and splenorenal ligaments. The underlying pathology of a wandering spleen is the laxity or maldevelopment of these suspensory ligaments, which permits the spleen to drift freely within the abdominal cavity. This mobility is facilitated by an abnormally long and flexible stalk of tissue, known as the splenic pedicle, which carries the organ’s blood vessels and nerves.
The causes are generally categorized as either congenital or acquired. Congenital cases, often identified in children, arise from a failure in the embryonic development of the dorsal mesogastrium, resulting in the ligaments not properly forming. Acquired factors are more common in adults, particularly women of reproductive age, likely due to hormonal changes and the mechanical stretching of abdominal tissues associated with multiple pregnancies. Other acquired causes include generalized connective tissue disorders that weaken supporting structures, or significant abdominal trauma.
Recognizing the Signs
The clinical presentation of a wandering spleen is highly variable, ranging from no symptoms to a severe, acute abdominal crisis. When symptoms are chronic, they often include vague, recurrent abdominal discomfort or pain. Patients may also feel a movable mass in the lower abdomen or pelvis. Nonspecific gastrointestinal issues such as nausea, vomiting, or a bloated feeling are common manifestations as the mobile spleen presses on adjacent organs.
The most serious and urgent manifestation is acute splenic torsion, which occurs when the elongated vascular pedicle twists upon itself. This twisting immediately compromises blood flow, blocking the splenic vein and artery, and leading to sudden, excruciating abdominal pain. The obstruction of blood supply rapidly causes the spleen to become congested and can result in splenic infarction, or tissue death. This acute event necessitates immediate medical attention.
Diagnosis and Treatment Options
Diagnosing a wandering spleen begins with a physical examination, where a physician may detect a palpable mass in an unusual location and note the absence of the spleen in its normal upper left quadrant. Imaging studies, such as ultrasound and Computed Tomography (CT) scans, are then used to confirm the diagnosis and assess the organ’s viability. A CT scan is particularly helpful as it demonstrates the spleen’s abnormal position and can reveal signs of torsion, such as the characteristic “whirl sign” created by the twisted pedicle.
Because of the high risk of life-threatening splenic torsion, surgical intervention is generally recommended even for asymptomatic patients. The goal of treatment is to prevent this complication and preserve the spleen’s infection-fighting function. If the spleen is still healthy and has not suffered irreversible damage, a procedure called splenopexy is performed to anchor the organ back to the abdominal wall. If the organ has already become necrotic due to complete torsion and infarction, a splenectomy, or surgical removal of the spleen, becomes necessary.