Wandering Spleen in Operated Case of Congenital Diaphragmatic Hernia

Abstract

Wandering spleen (WS) is a rare condition characterized by abnormal mobility of the spleen due to laxity or absence of its supporting ligaments. We report an exceptional case of WS in a pediatric patient who had previously undergone surgical repair for congenital diaphragmatic hernia (CDH). A 16-year-old male, with a history of CDH repair in infancy, presented with a two-day history of abdominal pain and vomiting. Clinical examination revealed abdominal distension, tenderness, and sluggish bowel sounds. Imaging studies, including a contrast-enhanced computed tomography (CECT) scan, indicated small bowel obstruction due to an internal hernia, potentially involving the foramen of Winslow. Intriguingly, the patient's spleen had migrated to the left iliac fossa, accompanied by partial thrombosis of the splenic vein. Surgical intervention was deemed necessary. During exploratory laparotomy, the patient was found to have a reversed anatomy, with the ascending colon, cecum, and appendix on the left side, and the small bowel on the right side. Additionally, a WS was discovered with a long and tortuous splenic vein and artery. Surgical procedures included adhesiolysis, primary closure of serosal tears, splenopexy for spleen repositioning, and bowel derotation. The patient's postoperative recovery was uneventful, and he was monitored closely to ensure the resolution of the complications associated with this unique presentation.