# Splenic torsion mistaken for an ovarian cyst: a case report 

## TL;DR

A case of a wandering spleen mistaken for an ovarian cyst highlights the challenges in diagnosing splenic torsion using limited imaging resources.

## Contribution

This case report adds to the clinical understanding of splenic torsion misdiagnosis in resource-limited settings.

## Key findings

- A wandering spleen with torsion was misdiagnosed as an ovarian cyst initially.
- CT scan confirmed the diagnosis of torsion and infarction of the wandering spleen.
- Splenectomy was performed, and the patient recovered well post-surgery.

## Abstract

Wandering spleen (or ectopic spleen) refers to a hyper-mobile spleen resulting in its displacement from the normal anatomical position to usually in the lower abdominal or pelvic cavity. While ultrasound is often the first radiological modality used, Computed Tomography (CT) shows a clear picture and aides to reach a diagnosis. In circumstances where appropriate imaging modalities are not available, or the operator is inexperienced, diagnosis of wandering spleen can be missed.

A 22-nulligravida unmarried Sindhi female had presented to the Emergency Room (ER) with a 5-day history of intermittent severe lower abdominal pain. An ultrasound at a local practitioner had suggested an ovarian cyst. Ultrasound-pelvis and later CT scan at our facility reported an enlarged wandering spleen with torsion of its pedicle and infarction. Exploratory laparotomy with splenectomy was done. An enlarged wandering spleen was found with torsion of the splenic vein and thrombosed arterial supply from omentum wrapped over the mass. The patient developed thrombocytosis post-surgery but otherwise did well and was discharged after 2 days.

Splenic torsion secondary to a wandering spleen can be challenging to diagnose, especially in resource limited settings where ultrasound might be the only modality available. Timely diagnosis and proper intervention are key to saving the life and the spleen.