A woman who went to the emergency room with abdominal pain soon learned the source of her discomfort: Her spleen had shifted about a meter from the site, according to a new case report.
This rare condition, known as a “wandering spleen,” occurs when the ligaments that normally hold the spleen in place loosen and stretch. The spleenwhich filters blood in the body and produces immune cells, usually located above the stomach in the left upper quadrant of the abdomen.
But when the 36-year-old woman showed up at Michigan Medicine in Ann Arbor, her doctors instead found her spleen in the right lower quadrant of her abdomen.
“He was traveling about 1
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Just two days before learning of her wandering spleen, the patient was screened for liver cancer, during which doctors took medical pictures of her abdomen and saw her spleen sitting in the right place. A day later, the woman began to experience abdominal pain and vomiting.
In the emergency department, doctors performed new scans, and during this time her spleen had traveled to the exact opposite side of her body.
But why does a woman’s spleen wander at all? The movement probably stems from it liverwhich connects to the spleen through a system of veins.
The woman had a liver disease called primary sclerosing cholangitis, a progressive disease marked by inflammation in the bile ducts, which carry digestive fluids from the liver to the small intestine, according to the Mayo Clinic. This inflammation causes severe scarring of the liver, known as cirrhosis, which makes it difficult for blood to flow through the body, Wester said.
“Like a clogged tube, this results in a backup of the blood, and one of the places to archive is the spleen,” he said. “Over time, the spleen enlarges, trying to hold all the excess blood.” As the spleen becomes larger, the ligaments around it can stretch, allowing the spleen to come out of its proper place in the upper abdomen. Thus, the wanderers.
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A stray spleen can also be caused by congenital conditions when babies are born with weak or missing ligaments that would normally stabilize the spleen, according to the National Organization for Rare Diseases. The condition can also occur in adulthood through physical trauma or other conditions that can weaken the ligaments near the spleen, such as connective tissue disease or even pregnancy.
The greatest danger of remaining a vagus spleen untreated is known as a splenic infarction, Wester said. “There are blood vessels that travel near the spleen that can warp and cut off the blood supply to the spleen,” he said. “It can cause severe pain and even death if left untreated.” The pancreas, which produces hormones and digestive enzymes, is also connected to the spleen through blood vessels and can become inflamed when the spleen deviates from its place.
The best treatment for a stray spleen is simply to remove the organ. “You can live without an intact spleen, and most patients need to have their spleen removed if they have this condition,” Wester said.
At the time, the patient was being tested for a liver transplant, and Wester noted that potential complications from having a splenectomy could undermine her candidacy for a new liver. In addition, if and when the patient qualifies for a new liver, both transplantation and removal of the spleen can be performed simultaneously, he added.
Thus, the patient’s splenectomy was postponed for some time in the future. Meanwhile, she received “treatment and hydration to control pain and abdominal pain and vomiting are allowed,” according to the case report.
Originally published in Live Science.