What is Wandering Spleen?
Wandering Spleen is an extremely rare birth defect in which there is complete absence or weakness of the ligaments which holds the spleen together in its normal anatomical position in the upper left abdomen. Wandering Spleen may be a birth defect but it is not congenital in origin.
In Wandering Spleen, instead of the spleen being attached to the ligaments, the spleen is attached by a form of a tissue which is supplied with blood vessels. This tissue is extremely sensitive and if any motion of the spleen causes the tissue to get rotated the blood supply may be obstructed or even blocked off completely resulting in ischemia to such an extent that there may be severe damage done to the blood vessels.
As there is nothing that binds the spleen in its normal anatomical position, it tends to wander in the lower abdomen where when a scanning is done for some other purpose it may look like an enlarged abdominal mass.
Anatomically speaking, the spleen is a small organ which is located in the left upper portion of the abdomen. The function of the spleen is to remove or filter out any waste products, break down old blood cells, and produce white blood cells to help the body fight infections.
The symptoms of a Wandering Spleen are similar to that of enenlarged spleen or splenomegaly. The enlargement is mostly because of the unusual twisting of the splenic arteries causing ischemia or obstruction of the arteries and in some cases formation of a blood clot in the spleen.
There is another form of Wandering Spleen, which is acquired. A child may have a wandering spleen due to an injury or some medical conditions that may make the ligaments holding the spleen weak such that the spleen starts to wander off from its normal position causing Wandering Spleen.
What are the Causes of Wandering Spleen?
What exactly causes Wandering Spleen is not yet known, but researchers are of the opinion that the cause of Wandering Spleen may be multifactorial. An infant born with Wandering Spleen may get this condition during the development stage of the fetus when there is some sort of abnormality in development causing weak ligaments and tissues holding the spleen together.
The child may be missing some or all the ligaments that are required to hold the spleen in its normal anatomical space. The unusual position of the spleen causes torsion of the tissues which are attached to it leading to obstruction and in some cases ischemia causing enlargement of the spleen.
Acquired form of Wandering Spleen may occur as a result of an injury or accident which may snap off the ligaments connecting the spleen. A connective tissue disorder is also one of the causes of acquired Wandering Spleen.
What are the Symptoms of Wandering Spleen?
The symptoms of Wandering Spleen are quite similar to that of an enlarged spleen or splenomegaly. While some children may not experience any symptoms due to this condition some children might complain of severe acute abdominal pain.
In majority of the cases, the abdominal pain is due to twisting or torsion of the splenic veins or arteries or the tissue that is attached to the spleen. Some of the other symptoms for Wandering Spleen are bulging mass in the abdomen, constipation, bloating, and nausea with or without vomiting along with difficulty with urination. In females along with the above symptoms, there may be menstrual irregularities due to Wandering Spleen.
In some cases, there may not be adequate blood supply to the spleen as a result of torsion of the tissues supplying blood to the spleen. This may result in symptoms like severe abdominal pain, splenomegaly, internal abdominal bleeding, splenic fibrosis, or necrosis of the splenic tissue due to lack of blood supply.
In cases where the blood supply to the spleen is significantly cut off, it may result in severe enlargement of the spleen, fatigue, bloody stools, hematemesis, and evidence of thrombocytopenia as a result of Wandering Spleen.
How is Wandering Spleen Diagnosed?
A diagnosis of Wandering Spleen can be made once a patient presents to the treating physician with acute abdominal pain and a distinct mobile bulge in the abdomen. The patient will feel relief of pain when the bulge is moved more towards the left side of the abdomen which is the normal anatomical position of the spleen. Once Wandering Spleen is suspected, the physician will order an ultrasound or other advanced radiological studies in the form of an MRI or a CT scan.
This will clearly show enlargement of the spleen and the spleen being out of position of its normal alignment. Additionally, Doppler studies to see for any abnormalities in the blood flow may detect presence of impaired blood flow into the spleen due to obstructed splenic artery and veins.
Specialized tests to check the function of the liver and spleen will show a dysfunctional spleen suggesting damage to the spleen as a result of it being out of position and reduced supply of blood to the organ due to obstruction and this will confirm the diagnosis of Wandering Spleen.
How is Wandering Spleen Treated?
As the spleen is an organ of the body that helps produce white blood cells which form a part of the immune system of the body and helps in fighting off infections, thus the treatment for Wandering Spleen is mainly aimed at preserving the spleen and protecting it from further damage and allowing it to function in its full capacity.
Since an individual can live more or less a normal life even if he or she does not have a spleen thus surgical removal of spleen is considered to be an option in cases of Wandering Spleen.
The more conservative approach towards treating Wandering Spleen is by observing the condition for a while and looking for any changes in the characteristics of the symptoms or any change in the size or shape of the bulge.
The patient will be recommended to avoid any type of sports or activity in which the patient may be at danger of injuring the abdominal area and further damaging the spleen.
For children with congenital forms of Wandering Spleen, surgery is the most recommended form of treatment in which the spleen is put back into its normal anatomical position. This procedure is called as splenopexy.
In majority of cases, the spleen is able to be preserved and the risk of twisting or torsion is minimized. Thus preservation of the spleen is more preferred than removal of spleen as complete removal of spleen may predispose the patient to many infections due to reduced production of white blood cells and hence a compromised immune system.
In case if there is significant damage done to the spleen as a result of Wandering Spleen and the symptoms are acute and uncontrollable even with conservative approach then a splenectomy may be the only choice left for treatment of Wandering Spleen.
Acute abdominal pain which cannot be controlled by standard means of treatment is a surgical emergency and calls for removal of spleen completely in cases of Wandering Spleen.