SHM Converge Scientific Abstract ePoster Gallery-Wandering Spleen Presenting as an Ileus in a Pediatric Patient: A Case Report

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This case report describes a 3-year-old previously healthy girl who presented with 1.5 weeks of constipation and worsening abdominal pain that progressed to a distended, firm acute abdomen. Initial CT imaging showed diffuse bowel gas and fecal impaction, with a non-visualized spleen suggesting congenital asplenia. Laboratory studies revealed marked thrombocytosis, leukocytosis, and anemia.<br /><br />She was initially treated conservatively with bowel rest, nasogastric decompression, and antibiotics. However, pediatric surgery re-reviewed the imaging and suspected splenic infarction rather than asplenia. The spleen was later identified in an unusual mid-abdominal location with torsed vessels. Doppler ultrasound confirmed absent blood flow, consistent with splenic torsion and infarction.<br /><br />The patient underwent splenectomy. Intraoperatively, she was found to have a thickened, fibrotic splenic pedicle with no ligamentous attachments, confirming wandering spleen. After surgery, she improved clinically and was discharged a few days later.<br /><br />The report emphasizes that wandering spleen is a rare cause of abdominal pain in children, resulting from laxity or absence of the spleen’s suspensory ligaments. Presentation may range from no symptoms to an acute surgical abdomen. Although ultrasound is often used for diagnosis, CT is especially helpful for assessing splenic location, blood flow, and viability. Surgical management is the main treatment to prevent serious complications such as torsion and infarction.<br /><br />The authors conclude that wandering spleen should be considered in pediatric patients with acute abdomen and thrombocytosis, and that early recognition and surgical intervention are essential for good outcomes.

Asset Subtitle

Reesha Bodiwala

Meta Tag

Author List Griffin Shoemaker, John Dinsmore, Lauren Tufts, Madison , S. Anderson, Reesha Bodiwala

Category Clinical Vignettes

Concept Wandering Spleen

Concept Splenic Torsion

Concept Splenic Infarction

Concept Computed Tomography

Concept Doppler Ultrasound

Distinguished Finalist

Presenter Organization Marshall University JCESOM, Marshall University Internal Medicine & Pediatrics Residency Program

Presenting Author Reesha Bodiwala

Track Pediatric

Keywords

wandering spleen

pediatric acute abdomen

splenic torsion

splenic infarction

splenectomy

abdominal pain

thrombocytosis

computed tomography

Doppler ultrasound

children

Wandering Spleen

Splenic Torsion

Splenic Infarction

Computed Tomography

Doppler Ultrasound