Wandering spleen presenting as acute pancreatitis in pregnancy.
BACKGROUND
Wandering spleen most frequently presents clinically with gastrointestinal bleeding and thrombocytopenia.


METHODS
A 24-year-old multiparous patient at 36 weeks' gestation presented with pancreatitis. Incidental thrombocytopenia was discovered. A 2722-g female neonate was delivered by repeat cesarean from a breech presentation. The spleen was observed at the left margin of the incision. An evaluation of the pancreatitis included a computed tomography study demonstrating an enlarged spleen twisted on its pedicle and displaced inferiorly. Esophagogastric duodenoscopy performed in evaluation of gastrointestinal bleeding showed persistent gastric varices. Multiple transfusions were required. A splenectomy was performed. The recovery was uncomplicated.


CONCLUSIONS
In this case of a wandering spleen, pancreatitis resulted from torsion and obstruction of the tail of the pancreas within the splenic pedicle and was effectively treated with splenectomy. Thrombocytopenia occurred as a result of sequestration of platelets in the enlarged spleen. Persistent gastric varices and subsequent gastrointestinal bleeding occurred secondary to splenic vein obstruction.
Gilman
Rachel S
RS
Department of Obstetrics and Gynecology, Allegheny General Hospital, The West Penn Allegheny Health System, Pittsburgh, Pennsylvania 15212, USA. rgilman@wpahs.org
Thomas
Ronald L
RL
D000208:Acute Disease; D000328:Adult; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D010182:Pancreatic Diseases / Q000175:diagnosis; D010195:Pancreatitis / Q000175:diagnosis* / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000209:etiology*; D013154:Spleen / Q000473:pathology*; D013156:Splenectomy; D013158:Splenic Diseases / Q000175:diagnosis; D013921:Thrombocytopenia / Q000209:etiology; D014102:Torsion Abnormality