The diagnostic challenge of wandering spleen with torsion: a rare cause of acute abdomen in children - a case report.

Introduction and Importance: Wandering spleen is a rare clinical entity, affecting fewer than 0.5% of pediatric abdominal emergencies. It is caused by laxity or absence of the splenic ligaments, permitting abnormal mobility. Splenic torsion, as its most severe complication, leads to vascular compromise and infarction, which necessitates urgent intervention to prevent life-threatening outcomes. Presentation of case: An 8-year-old girl presented to a resource-limited emergency department with 24 hours of severe abdominal pain and a palpable right iliac fossa mass. Ultrasound revealed an ectopic, solid "liver-like" mass with some preserved perfusion, highly suspicious for a torsed wandering spleen. Emergency laparotomy demonstrated 720° torsion with infarction, necessitating splenectomy. The patient recovered well and was discharged with arrangements for post-splenectomy vaccinations. Clinical discussion: Wandering spleen is a rare mimic of common abdominal emergencies. While ultrasound is a valuable initial diagnostic tool, surgical findings ultimately dictate management. The decision between splenopexy and splenectomy hinges on intraoperative viability assessment. In cases of infarction, splenectomy is mandatory, followed by vital vaccinations. Large recent review articles confirm that ultrasound-based diagnosis is critical, and contrast-enhanced CT is used in complex cases. Splenectomy remains common for infarcted spleens. Conclusion: This case highlights that wandering spleen with torsion, though rare, must be considered in the differential diagnosis for children presenting with acute abdominal pain and atypical masses. Clinical assessment and ultrasound are vital for guiding urgent management, especially when advanced imaging such as CT is unavailable.