A rare case of wandering spleen with its unreported associations: case report and literature review

Abstract

Wandering spleen (WS) is a rare clinical entity with unclear clinical picture. Patient can be asymptomatic or can present with acute abdomen, based on the degree of associated splenic torsion, but most of the cases needed an emergency splenectomy. We herein report an unusual presentation of a wandering spleen in the elderly with thrombocytosis, portal, and splenic vein thrombosis, and sinistral hypertension. To the best of our knowledge, this is the first case report documenting all these associations altogether. This case report describes how this challenging case was managed well. Splenectomy was inevitable in this patient as the spleen was infarcted. This enlightens the need for timely diagnosis and intervention of wandering spleen for splenic preservation.

Etiologies of Splenic Venous Hypertension: A Review

“…It predisposes to splenic torsion and SVT, leading to SVH. 39 A review of 20 case reports found that GI bleeding was the most common chief complaint (45%), followed by abdominal pain (40%). Gastric varices were observed in 90% of the patients, 30% had splenic varices, and no esophageal varices were present.…”

“…Several case reports have also been published (Tables 1D and 2D). 39,41 Essential thrombocythemia: Essential thrombocythemia is a myeloproliferative neoplasm characterized by JAK/STAT pathway activation, leading to elevated platelet levels with an increased risk of thrombosis, including in the SV with consequent SVH. The estimated prevalence of SVT is 4% to 13%.…”

“…If SVH persists, splenectomy is recommended. 39,40 Splenectomy and partial splenic embolization have been proposed for PMF. 45,46,47,76 Similarly, resolution of gastric varices has been achieved by partial splenic embolization or gastric devascularization in patients with ET.…”