Asian Journal of Case Reports in Surgery

Introduction and Importance: Wandering spleen (WS) is a rare anatomical anomaly characterized by splenic hypermobility due to ligamentous deficiency. It exhibits a marked predilection for women of reproductive age, often exacerbated by the mechanical and hormonal stress of pregnancy and the postpartum period. WS can lead to life-threatening complications, primarily splenic pedicle torsion and infarction.

Presentation of Case: We report the case of a 25-year-old G1P1 woman presenting four months postpartum with a three-month history of intermittent, dull abdominal pain in the left hypochondrium. Physical examination revealed a firm, mobile, non-tender mass. Initial laboratory workup noted mild isolated thrombocytopenia. Contrast-enhanced Computed Tomography (CT) confirmed the diagnosis, revealing an ectopic spleen, partial splenic infarction, and the pathognomonic "whirl sign," indicating chronic torsion of the vascular pedicle.

Clinical Discussion: This case underscores the critical need to include WS in the differential diagnosis of abdominal pain in the postpartum setting, where it can mimic more common gynecological pathologies. Due to established partial infarction and significant splenomegaly, splenectomy via open midline laparotomy was performed. Intraoperative findings confirmed the absence of suspensory ligaments and chronic torsion.

Conclusion: This report emphasizes that timely CT imaging is essential for confirming torsion and assessing splenic viability. While splenopexy is preferred for preservation, splenectomy is necessitated by established infarction. High clinical suspicion, even in cases with chronic presentation, and appropriate surgical intervention lead to favorable long-term outcomes, including normalization of hematological indices.