Wandering spleen and intestinal malrotation in a 14-year-old female: a case report

Introduction: Wandering spleen is an uncommon condition. It is often associated with congenital anomalies affecting the splenic ligaments and can result in complications such as splenic torsion and infarction. Case presentation: A 14-year-old female presented with moderate epigastric pain accompanied by fever, non-bilious vomiting, abdominal distension, and absence of bowel movements for 48 hours. She was tachycardic, febrile, and exhibited diffuse abdominal tenderness with guarding. Laboratory investigations revealed leukocytosis and elevated inflammatory markers. Abdominal ultrasound showed a spleen located in the lower abdomen, with absent blood flow. Contrast-enhanced computerized tomography (CT) confirmed a torsed, infarcted spleen in an ectopic position, along with features suggestive of intestinal malrotation: abnormally positioned duodenojejunal junction and a narrow mesenteric root. The patient underwent emergency exploratory laparotomy. We found a twisted spleen with infarction, and intestinal malrotation without volvulus. We did a splenectomy and a Ladd procedure, including a prophylactic appendectomy. Her postoperative course was uneventful, and she was discharged in stable condition. Follow-up visits 6 and 12 months later revealed normal growth, absence of gastrointestinal symptoms, and no complications related to asplenia. One year later, however, she developed type 1 diabetes for unknown reasons. Conclusion: Wandering spleen with splenic torsion should be consider in the differential diagnosis of children who present with acute abdominal pain. Intestinal malrotation should be ruled out in patients with wandering spleen, as both conditions can coexist.