Wandering Spleen with 720-degree Torsion Treated with Splenectomy and Distal Pancreatectomy

[...]the spleen is left mobile and likely to be found elsewhere in the abdominal cavity, allowing it to twist around its pedicle, leading to torsion.2 The severity of the torsion determines the likelihood of splenic necrosis, which can lead to a splenectomy. The spleen becomes tethered to the abdominal wall by an abnormally elongated vascular pedicle, increasing risks for splenic pedicle torsion that can incorporate surrounding organs, and vasculature.2 Other congenital and acquired causes include congenital renal anomalies, Gaucher's disease, Hodgkin's lymphoma, malaria, and mononucleosis.3 There seems to be a bimodal age distribution for diagnosis of wandering spleen and a predominance in females as adults, especially in the third decade.2 Female predominance in the third decade of life can be associated with resulting ligament laxity during pregnancy because of hormonal effects and abdominal wall weakness.2 There also seems to be a difference in initial presentation between the pediatric and adult population.4 Children often present with sudden onset of abdominal pain, whereas adults commonly present with an abdominal mass that may be associated with other gastrointestinal symptoms.1 The severity of symptoms and the acuity of the patient increase significantly when the spleen begins to undergo torsion around the vascular pedicle and undergoes ischemia. Because of the increased variability of physical examination findings in patients, the diagnosis of a wandering spleen relies heavily on radiologic imaging.