Congenital wandering spleen is a very rare, randomly distributed birth defect characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the upper left abdomen. The disorder is not genetic in origin. Instead of ligaments, the spleen is attached by a stalk-like tissue supplied with blood vessels (vascular pedicle). If the pedicle is twisted in the course of the movement of the spleen, the blood supply may be interrupted or blocked (ischemia) to the point of severe damage to the blood vessels (infarction). Because there is little or nothing to hold it in place the spleen "wanders" in the lower abdomen or pelvis where it may be mistaken for an unidentified abdominal mass.
The spleen is a small organ located in the upper left portion of the abdomen. The spleen removes or filters out unnecessary or foreign material, breaks down and eliminates worn out blood cells, and produces white blood cells, which aid the body in fighting infection. Symptoms of wandering spleen are typically those associated with an abnormally large size of the spleen (splenomegaly) or the unusual position of the spleen in the abdomen. Enlargement is most often the result of twisting (torsion) of the splenic arteries and veins or, in some cases, the formation of a blood clot (infarct) in the spleen.
"Acquired" wandering spleen may occur during adulthood due to injuries or other underlying conditions that may weaken the ligaments that hold the spleen in its normal position (e.g., connective tissue disease or pregnancy).
Some children with wandering spleen may have no symptoms (asymptomatic), while others may experience acute or chronic abdominal pain. In most cases, episodes of pain may be related to the spontaneous twisting and untwisting of the mobile spleen (torsion and detorsion) or of the blood vessels serving the spleen. Infants with wandering spleen may attempt to relieve pain by stretching. Other symptoms may include a bulging abdominal mass, constipation, bloating, nausea, vomiting, frequent difficult urination, and/or menstrual problems in women.
In some cases, the spleen may lack proper blood supply due to the twisting of the splenic arteries. In these cases, symptoms may include abdominal pain, abnormal enlargement of the spleen (splenomegaly), bleeding into the abdomen (infarct), the accumulation of fibrous tissue in the spleen (fibrosis), and/or decay of splenic tissue (necrosis). In severe cases, blood flow into the spleen is diminished and the spleen may become greatly enlarged, as it accumulates (sequesters) blood elements such as platelets and red blood cells. Resulting symptoms may include fatigue, weakness, blood in the stools, anemia, bloody vomit (hematemesis), and/or an abnormally low level of blood platelets (thrombocytopenia).
In adulthood, wandering spleen most often causes abdominal pain or present as an abdominal mass that does not cause symptoms (asymptomatic).
The exact cause of wandering spleen is not known. Researchers suspect that multiple factors play a role in the development of the disorder (multifactorial).
Babies may be born with a wandering spleen that may be the result of a defect in a certain area of the developing embryo (mesogastrium dorsum). This is the area of the embryo that gives rise to the ligaments that normally hold the spleen in the upper left abdomen. Affected children may be missing one or all of these ligaments, or, if present, the ligaments are not positioned properly. Symptoms usually develop due to the abnormal position of the spleen in the lower abdomen or because of the abnormal enlargement of the spleen (splenomegaly).
Wandering spleen may occur during adulthood because of accident or injury, another underlying disorder (e.g., connective tissue disease), or the abnormal relaxation (laxity) of the ligaments caused by pregnancy.
Wandering spleen, whether it is a condition with which a baby is born (congenital form) or is the result of multiple births in women or some sort of accident that may affect men and women (acquired form), is an extremely rare disorder. Fewer than 500 cases of wandering spleen have been reported in the medical literature.
The incidence of wandering spleen is unknown and, because the condition may be underdiagnosed, is difficult to determine. It usually reported between the ages of 20 and 40 years with sex ratios of 7 females to 1 male. Most women are of reproductive age at the time of presentation. Children make up about a third of all cases, with 30 percent under 10 years of age. Among such children, the male-female ratio is 1:1.
As noted, acquired wandering spleen is acquired usually during adulthood, and it affects females many times more frequently than males. This is probably due to the relaxation (laxity) of the splenic ligaments during the childbearing years. Pregnancy is thought to contribute to the laxity, which increases the frequency of acquired wandering spleen among women who have had children.
The diagnosis of wanderin. spleen is suspected when the pain associated with an abdominal mass can be relieved by moving it toward the upper left quadrant of the abdomen, the normal position of the spleen. Wandering spleen may be confirmed by specialized examinations such as ultrasonography and CT scan that enable the physician to view the structure, size, and placement of the spleen within the abdomen or pelvis. Specialized ultrasound tests (i.e., Doppler studies) may show impaired blood flow in and out of the spleen. Radioisotopic scanning (technetium 99 sulfur colloid scan), another imaging test, allows the physician to determine how well the liver and spleen are functioning. Low spleen function (functional asplenia) may suggest that the organ is damaged as a result of arterial obstruction (infarct).
The treatment of wandering spleen depends on the severity of symptoms and a thorough evaluation to determine the size, location, and functional status of the spleen. Since the spleen helps to maintain the proper function of the blood and immune system, most treatments are aimed at conserving the spleen and maximizing its function. However, since a person can live reasonably well without a spleen, surgical removal is considered.
The most conservative approach to the treatment of wandering spleen includes watchful waiting while observing splenic function and/or enlargement. Prevention of injury by avoiding contact sports or other activities that might threaten the spleen is also a part of the conservative approach.
For children with congenital wandering spleen who are experiencing episodes of torsion and acute pain, the treatment of choice may be surgery that anchors the spleen back in the proper position in the upper left abdomen (splenopexy). In many cases, the spleen can be preserved and the risk of torsion and infarct is reduced. Preservation of the spleen is preferred to removal through surgery because absence of the spleen can make a person vulnerable to certain infections.
If wandering spleen causes chronic abdominal pain, abnormal enlargement of the spleen, and/or deficiencies of one or more necessary blood elements (i.e., thrombocytopenic hypersplenism), the treatment of choice is usually surgery to remove the spleen (splenectomy). Acute abdominal pain associated with wandering spleen is considered a surgical emergency and may require immediate splenectomy.
The potential complications of complete removal of the spleen (splenectomy) may include postsplenectomy infection syndrome, which includes life-threatening bacterial infections (sepsis). People who have had a splenectomy are at higher lifetime risk for serious infections than the general population. Immunizations to boost immunity against haemophilus influenzae B, streptococcus pneumoniae, seisseria meningitis, and other contagious diseases are usually administered before the splenectomy is performed. All people who have had a splenectomy must be observed carefully in case of fever or other symptoms of infection. Antibiotics may be prescribed to help prevent infectious disease (prophylaxis), especially in children under the age of 2 years.
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