Introduction: 

Wandering spleen is a rare clinical entity characterized by excessive splenic mobility due to congenital or acquired laxity of its supporting ligaments. This predisposes the spleen to torsion of its vascular pedicle, leading to congestion, infarction or rupture. Because of its nonspecific presentation, diagnosis is often delayed, increasing the risk of life-threatening complications. We present a case of splenic volvulus in a 13-year-old girl with a wandering spleen. This case underscores the importance of early imaging and prompt surgical intervention to prevent irreversible ischemic injury and associated morbidity. 

Case Description: 

A 13-year-old girl presented with a six-day history of abdominal pain, fever, and vomiting. Physical examination revealed tachycardia and tenderness in the left upper quadrant of the abdomen. Laboratory investigations demonstrated leukocytosis and elevated C- Reactive protein levels. Abdominal Ultrasonography identified an ectopic spleen in the pelvis with a “whirlpool sign,” while contrast-enhanced CT confirmed torsion of the splenic pedicle with infarction. Laparoscopic exploration revealed a necrotic spleen with multiple pedicle twists, necessitating conversion to open splenectomy. The postoperative course was uneventful, and the patient was discharged on antibiotic prophylaxis after receiving appropriate vaccination. 

Discussion: 

Splenic torsion secondary to a wandering spleen is exceedingly rare, accounting for less than 0.2% of splenectomies in pediatric populations [3]. Early diagnosis using Doppler ultrasound and CT imaging is vital, with the “whirlpool sign” being a characteristic feature [13]. Splenopexy is preferred for viable spleens, whereas infarction necessitates splenectomy [16].

Conclusion: 

High clinical suspicion, prompt imaging, and timely surgical management are critical for preventing irreversible ischemic injury in cases of wandering spleen. Increased awareness among pediatric clinicians can improve diagnostic accuracy and patient outcomes.

Nusrath Beegam is a highly experienced Consultant in Pediatric Emergency Medicine, currently practicing at Al Jalila Children’s Specialty Hospital in Dubai, UAE. With over 15 years of extensive clinical experience across India and the United Arab Emirates, she has established herself as a dedicated and skilled physician in the management of acute and critical pediatric conditions. She completed her MBBS, Postgraduate Diploma in Child Health (DCH), and Diplomate of National Board (DNB) in Pediatrics from Government Medical College, Calicut, India. She further enhanced her expertise by obtaining a Fellowship in Pediatric Emergency Medicine (FACEE, India). In 2025, she achieved certification in Pediatric Point-of-Care Ultrasound (POCUS) from Mohammed Bin Rashid University. She has a strong interest in research and quality improvement. She has authored multiple peer-reviewed publications in reputable journals and has presented her work at international pediatric and emergency medicine conferences. She actively leads and participates in clinical audits and quality improvement initiatives, focusing on enhancing patient care standards in pediatric emergency settings. Her contributions have been recognized through numerous awards and certificates of appreciation for academic presentations, research contributions, and excellence in clinical service.