Summary about Disease
Wandering spleen, also known as ectopic spleen or splenic ptosis, is a rare condition where the spleen is not attached in its normal position in the upper left quadrant of the abdomen. Instead, it is attached by an elongated or absent suspensory ligament, allowing it to "wander" to other areas of the abdomen or pelvis. This abnormal mobility can lead to various complications, primarily due to torsion (twisting) of the splenic pedicle (the vessels and ligaments that supply the spleen). This torsion can compromise blood flow, leading to splenic infarction (tissue death) and abdominal pain.
Symptoms
Symptoms can vary depending on the location of the wandering spleen and the degree of torsion:
Abdominal or Pelvic Pain: This is the most common symptom. Pain can be intermittent or constant, and may worsen with activity or palpation. The location of the pain depends on where the spleen has migrated.
Palpable Abdominal Mass: In some cases, the wandering spleen can be felt as a mass in the abdomen or pelvis.
Nausea and Vomiting: These symptoms can occur if the wandering spleen is pressing on other abdominal organs.
Constipation or Diarrhea: Bowel changes can result from pressure on the intestines.
Urinary Frequency: Pressure on the bladder can lead to increased urination.
Asymptomatic: Some individuals may have a wandering spleen without experiencing any symptoms, particularly if there is no torsion.
Splenic Torsion Symptoms: Acute severe abdominal pain, fever, nausea, vomiting, and signs of peritonitis (inflammation of the abdominal lining) due to compromised blood flow.
Causes
The primary cause of wandering spleen is a weakness or absence of the ligaments that normally hold the spleen in place. This can be due to:
Congenital: Present at birth, often related to developmental abnormalities of the splenic ligaments.
Acquired:
Multiparity: Multiple pregnancies can stretch and weaken abdominal ligaments.
Connective Tissue Disorders: Conditions like Ehlers-Danlos syndrome can cause ligamentous laxity.
Trauma: Abdominal trauma can damage or tear the splenic ligaments.
Splenomegaly: An enlarged spleen, regardless of cause, may pull on and weaken the ligaments.
Medicine Used
There is no specific medication to "treat" wandering spleen directly. Treatment primarily focuses on addressing complications and ultimately involves surgical intervention.
Pain Management: Analgesics (pain relievers) may be used to manage abdominal pain while awaiting definitive treatment.
Antibiotics: In cases of splenic infarction or infection, antibiotics may be necessary.
Anticoagulants: May be considered if there is a high risk of blood clot formation due to splenic torsion.
Vaccinations: After a splenectomy, vaccinations against encapsulated bacteria (e.g., Streptococcus pneumoniae, *Neisseria meningitidis*, *Haemophilus influenzae* type b) are crucial to prevent overwhelming post-splenectomy infection (OPSI).
Is Communicable
Wandering spleen is not communicable. It is not an infectious disease and cannot be spread from person to person.
Precautions
There are no specific precautions to prevent wandering spleen, as it is usually due to congenital factors or other underlying conditions. However, the following are general health recommendations:
Prenatal Care: Adequate prenatal care can help reduce the risk of congenital abnormalities.
Injury Prevention: Avoiding abdominal trauma can help prevent acquired wandering spleen.
Prompt Medical Attention: If you experience abdominal pain or suspect you have a wandering spleen, seek medical attention promptly for diagnosis and treatment.
Post-Splenectomy Precautions: If splenectomy is performed, follow all post-operative instructions, including vaccinations and antibiotic prophylaxis as prescribed by your doctor to prevent infection.
How long does an outbreak last?
Wandering spleen is not an infectious disease and does not have "outbreaks." The condition is chronic, meaning it persists until treated (usually surgically). The duration of symptoms depends on whether there is torsion. If there is intermittent torsion, symptoms can come and go. If there is complete torsion, symptoms will be acute and severe.
How is it diagnosed?
Diagnosis typically involves:
Physical Examination: Palpation of an abdominal mass in an unusual location may raise suspicion.
Imaging Studies:
Ultrasound: Can often visualize the ectopic spleen.
CT Scan with IV Contrast: Provides detailed images of the abdominal organs and blood vessels, allowing for confirmation of the diagnosis and evaluation of the splenic vasculature (torsion/infarction). This is the gold standard diagnostic method.
MRI: Another imaging option that can provide detailed information.
Radionuclide Scan (e.g., sulfur colloid scan): Rarely used but can show splenic tissue outside of the normal location.
Medical History: Reviewing the patient's medical history, including any previous pregnancies, trauma, or connective tissue disorders.
Timeline of Symptoms
The timeline of symptoms can vary significantly:
Congenital: May be detected incidentally at any age or may present with symptoms in childhood or adulthood.
Gradual Onset: Mild, intermittent abdominal pain may be present for months or years before diagnosis.
Acute Onset: Sudden, severe abdominal pain with signs of torsion and splenic infarction requires immediate medical attention.
Asymptomatic: Some individuals may have a wandering spleen discovered incidentally without ever experiencing symptoms.
Post-Diagnosis/Pre-Treatment: If diagnosed and awaiting surgery, symptoms can fluctuate depending on activities and potential for torsion.
Important Considerations
Differential Diagnosis: It is crucial to differentiate wandering spleen from other causes of abdominal pain, such as ovarian cysts, ectopic pregnancy, appendicitis, or bowel obstruction.
Surgical Intervention: Splenopexy (suturing the spleen to the abdominal wall to secure its position) is the preferred surgical treatment if the spleen is viable. Splenectomy (surgical removal of the spleen) may be necessary if the spleen is infarcted or non-viable. Laparoscopic approaches are frequently used.
Post-Splenectomy Care: Patients who undergo splenectomy require lifelong monitoring due to the increased risk of infection. They need to receive vaccinations against encapsulated bacteria and may need prophylactic antibiotics, especially in young children.
Fertility Considerations: In women of childbearing age, splenopexy is preferred to preserve splenic function and reduce the risk of complications during future pregnancies.
Psychological Impact: Chronic abdominal pain and the potential need for surgery can have a significant psychological impact. Supportive care may be beneficial.