Wandering Spleen: Symptoms, Types, Causes and Treatment

Wandering spleen is a rare but fascinating medical condition that can pose serious health risks if left undiagnosed or untreated. Unlike most abdominal organs, the spleen in these cases is not properly anchored, allowing it to "wander" throughout the abdomen or even the pelvis. This mobility can lead to dramatic twists and turns—literally—sometimes resulting in life-threatening complications. In this comprehensive article, we’ll explore the symptoms, types, causes, and modern treatment options for wandering spleen, drawing on the latest research and case studies.

Symptoms of Wandering Spleen

Wandering spleen often presents a diagnostic puzzle. Its symptoms are notoriously variable, sometimes mimicking more common abdominal disorders and, in some cases, remaining completely silent until a complication arises. Recognizing the range of potential symptoms is crucial for early diagnosis and successful management.

Symptom	Description	Clinical Relevance	Source(s)
Abdominal pain	Intermittent or acute pain; often in the lower or central abdomen	Most common symptom; may indicate torsion/infarction	1,2,7,8,13
Abdominal mass	Palpable, mobile mass	May be the first or only sign; can be misdiagnosed	3,8,7
Nausea/Vomiting	Gastrointestinal symptoms	Often occurs with torsion or obstruction	4,8
Acute abdomen	Severe, sudden pain	Indicates emergency; possible infarction	1,2,3,8,14

Table 1: Key Symptoms

Abdominal Pain: The Most Common Clue

Most patients with wandering spleen report abdominal pain, but its nature can range from mild and intermittent discomfort to severe, acute pain signaling an emergency. The pain may shift location, reflecting the spleen's abnormal mobility. Sudden, intense pain can be a sign of splenic torsion, where the spleen twists on its vascular pedicle, cutting off blood supply and risking infarction 1,2,3.

Palpable and Mobile Abdominal Mass

A mobile mass in the abdomen, sometimes described as a “moving lump,” can be detected during a physical exam. Its mobility is a distinguishing feature, but it is often misattributed to other intra-abdominal pathologies, especially in children and young women 3,7,8.

Gastrointestinal Symptoms

Nausea, vomiting, and signs of intestinal obstruction may accompany wandering spleen, especially when the displaced organ compresses nearby structures or when torsion impairs gastrointestinal function. Swelling or fullness may also be reported 4,8.

Acute Abdomen and Emergency Presentation

In some cases, the first symptom is a dramatic, acute abdomen—a surgical emergency. Torsion of the spleen’s vascular pedicle can lead to infarction and, without quick intervention, life-threatening complications 1,2,8,14. Emergency physicians should maintain a high index of suspicion for wandering spleen in patients, especially young women and children, presenting with unexplained left-sided or lower abdominal pain.

Types of Wandering Spleen

Wandering spleen is not a uniform condition; it can present in different forms depending on its origin and anatomical features. Understanding these types helps tailor diagnosis and management strategies.

Type	Description	Common Presentation	Source(s)
Congenital	Due to abnormal ligament development	Childhood or young adulthood	5,6,10,13
Acquired	Ligamentous laxity from other causes	More common in women, especially during/after pregnancy	5,7,6
With Torsion	Spleen twists on its pedicle	Acute abdomen, infarction risk	1,2,3,8,10
Without Torsion	Mobile spleen, no twist yet	Often asymptomatic or mild symptoms	3,7,13

Table 2: Types of Wandering Spleen

Congenital Wandering Spleen

This type results from the underdevelopment or absence of the spleen’s suspensory ligaments during fetal growth. It is more frequently diagnosed in children but can also be found in young adults 5,6,13. Both boys and girls may be affected, though older data show a female preponderance later in life.

Acquired Wandering Spleen

Acquired forms develop due to conditions causing ligamentous laxity, such as pregnancy, abdominal trauma, or splenomegaly (enlarged spleen). Hormonal changes and the physical stretching of abdominal tissues during pregnancy make women of reproductive age particularly vulnerable 5,7.

Wandering Spleen With or Without Torsion

The clinical course depends on whether the spleen undergoes torsion. A spleen that has not twisted may present only mild or intermittent symptoms—or none at all. However, once torsion occurs, blood supply is compromised, raising the risk of infarction and necessitating emergency intervention 1,2,8,10.

Other Associated Features

• Splenic Volvulus: Sometimes the spleen twists so extensively it causes a volvulus, or complete rotation, which is a surgical emergency 2.
• Associated Cysts or Masses: In rare cases, wandering spleen may be accompanied by cysts or other benign growths, further complicating the clinical picture 15.

Causes of Wandering Spleen

Understanding why the spleen "wanders" is key to both prevention and treatment. Causes fall into two broad categories: congenital (present from birth) and acquired (developing later in life).

Cause	Mechanism	Risk Groups	Source(s)
Congenital	Maldevelopment or absence of ligaments	Children, young adults	5,6,10,13
Acquired	Ligament laxity due to pregnancy, trauma, splenomegaly	Women of reproductive age, patients with enlarged spleen	5,7,9
Abdominal trauma	Disrupts ligament attachments	Any age	5,7
Splenomegaly	Weight stretches ligaments	Patients with underlying diseases	5,9

Table 3: Causes of Wandering Spleen

Congenital Ligament Defects

From birth, some individuals lack the normal supporting ligaments of the spleen (the gastrosplenic, splenorenal, and phrenicocolic ligaments). Without these, the spleen is free to move within the abdominal cavity, suspended only by its blood vessels. This form is often discovered in childhood but can remain undetected until adulthood 5,6,10.

Acquired Ligament Laxity

Ligaments that were once normal may become overstretched or weakened due to:

• Pregnancy: Hormonal changes and physical stretching can weaken abdominal ligaments, especially in multiparous (having had multiple pregnancies) women 5,7.
• Splenomegaly: Enlargement of the spleen, due to infection, hematologic disease, or congestion, increases its weight, stretching supporting tissues 5,9.
• Abdominal Trauma or Surgery: Direct injury or previous surgical procedures can disrupt ligamentous support 5,7.

Additional Contributing Factors

• Connective Tissue Disorders: Although rare, some systemic conditions affecting connective tissue strength and elasticity may predispose individuals to wandering spleen 5.
• Age and Gender: Children (especially under 10) and women of reproductive age are at greater risk, likely due to developmental and hormonal factors 13.

Treatment of Wandering Spleen

The management of wandering spleen has evolved considerably. Early diagnosis is crucial, as prompt intervention can prevent loss of splenic function and life-threatening complications. Treatment strategies depend on the spleen’s condition at diagnosis and the patient’s overall health.

Treatment	Approach	Indication	Source(s)
Splenopexy	Surgical fixation of spleen	Viable spleen, no infarction	7,11,12,13,15
Splenectomy	Surgical removal of spleen	Infarcted or necrotic spleen	1,2,3,7,8,13,14
Laparoscopic	Minimally invasive surgery	Preferred in eligible cases	7,13,15
Emergency Surgery	Urgent intervention	Acute torsion, infarction	14,8

Table 4: Treatment Options

Splenopexy: Saving the Spleen

Whenever possible, surgeons aim to preserve the spleen, given its crucial immune function. Splenopexy involves repositioning and anchoring the spleen in its normal location. Several techniques exist:

• Retroperitoneal pouch creation: The spleen is placed in a surgically created pocket behind the peritoneum 13.
• Mesh fixation: Synthetic mesh is used to wrap and secure the spleen 12,15.
• Omental or peritoneal flaps: Using the body’s own tissues to anchor the spleen 11.

Laparoscopic (minimally invasive) splenopexy is increasingly favored for its quicker recovery and lower complication rates 7,13,15. Success rates are high, especially when performed before torsion or infarction has occurred.

Splenectomy: When the Spleen Can’t Be Saved

If the spleen has already undergone infarction (tissue death from lack of blood supply), removal is necessary to prevent infection, abscess, or sepsis 1,2,3,7,8. Splenectomy was once the default treatment but is now reserved for cases where splenic preservation is impossible.

Important note: Patients who undergo splenectomy require lifelong precautions and vaccinations to prevent overwhelming infection, as the spleen is vital for fighting certain bacteria 11,13.

Emergency and Delayed Interventions

Delays in diagnosis can convert a potentially elective surgery into an emergency, increasing the risk of complications and the likelihood of needing splenectomy. Prompt imaging and a high index of suspicion are key to improving outcomes 14.

Special Considerations

• Children: Splenic preservation is especially emphasized due to the high risk of severe post-splenectomy infections in this group 12,13.
• Pregnancy: Diagnosis and management are more complex, but splenopexy is preferred when feasible 4.
• Associated Lesions: Co-existing cysts or masses can often be managed simultaneously with splenopexy using minimally invasive techniques 15.

Conclusion

Wandering spleen remains a diagnostic and therapeutic challenge due to its rarity and variable presentation. However, awareness of its symptoms, types, causes, and evidence-based treatments can dramatically improve patient outcomes.

Key Takeaways:

• Wandering spleen often presents with non-specific symptoms, most commonly abdominal pain and a mobile mass.
• There are congenital and acquired types, with torsion representing the most dangerous complication.
• Causes include congenital ligament defects, pregnancy, splenomegaly, and trauma.
• Splenopexy is the preferred treatment for viable spleens, especially in children, while splenectomy is reserved for infarcted or necrotic organs.
• Early diagnosis and timely surgical intervention are crucial to avoid emergency situations and preserve splenic function.

By maintaining a high index of suspicion and using modern surgical techniques, clinicians can offer patients the best chance for a healthy, complication-free life—even when their spleen decides to "wander."