Wandering Spleen in Pediatric Patients: Diagnostic Challenges and Management

In a tertiary care setting, the management of wandering spleen cases in pediatric patients poses a diagnostic challenge due to the abnormal mobility of the spleen caused by lax or absent supporting ligaments. This rare condition can lead to acute torsion and infarction, emphasizing the importance of early identification through imaging and timely intervention to preserve splenic function. Three distinct cases in pediatric patients highlight the varied clinical presentations and surgical management strategies associated with wandering spleen.

In the first case, a 13-year-old girl presented with progressive abdominal pain and vomiting, leading to splenectomy after unsuccessful detorsion attempts. The second case involved a 10-year-old girl with a known pelvic spleen, successfully treated with laparotomy and splenopexy to preserve partial spleen viability. The third case featured a 3-year-old girl with fever and acute pain, where intraoperative detorsion and splenopexy were performed to salvage splenic tissue. These cases underscore the importance of individualized management and the priority of splenic salvage whenever feasible to maintain immune function.

Wandering spleen is a rare condition in children, often resulting from congenital anomalies or acquired weakening of supporting ligaments. The potential for torsion around the vascular pedicle poses a significant threat, necessitating prompt diagnosis and intervention. Advanced imaging techniques such as color Doppler ultrasound and contrast-enhanced CT play a crucial role in assessing splenic perfusion and guiding treatment decisions based on splenic viability.

Splenopexy is the preferred option for viable spleens to maintain immunologic function, while splenectomy is reserved for nonviable organs. The choice between surgical approaches depends on the spleen’s condition and the surgical team’s expertise with minimally invasive techniques. High-volume pediatric centers with experience in laparoscopic procedures tend to achieve better outcomes in terms of splenic salvage rates and operative efficiency.

Following splenectomy, children require vaccination against encapsulated organisms to prevent overwhelming infections. Postoperative care involves a series of vaccinations and prophylactic measures to mitigate the risks associated with asplenia. Regular follow-up and monitoring are essential to ensure optimal outcomes in pediatric patients with wandering spleen, emphasizing the importance of a multidisciplinary approach involving pediatric surgeons and infectious disease specialists.

In conclusion, wandering spleen represents a unique clinical entity that requires a high index of suspicion for timely diagnosis and appropriate management. The cases presented in this study illustrate the diverse clinical courses and surgical interventions associated with this condition, highlighting the significance of tailored treatment strategies and vigilant postoperative care to ensure the best possible outcomes for pediatric patients with wandering spleen.