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.
Department of Obstetrics and Gynecology, Allegheny General Hospital, The West Penn Allegheny Health System, Pittsburgh, Pennsylvania 15212, USA. rgilman@wpahs.org
Rachel S
RS
Gilman
Ronald L
RL
Thomas
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