A wandering spleen with 720° torsion and persistent ascending and descending mesocolon in a 5-year-old Syrian male: A case report()

INTRODUCTION AND IMPORTANCE: The spleen is normally found in the left hypochondrium and it is fixed in its place by numerous suspensory ligaments. When the ligaments are elongated or abnormally developed, it causes a rare medical condition called Wandering spleen. A persistent ascending and descending mesocolon is also a congenital anomaly, resulting from the failure of fusion of the primitive dorsal mesocolon. CASE PRESENTATION: Herein, a 5-year-old male child with sudden and acute onset of abdominal pain, constipation, nausea, tachycardia, and low urine output, imaging and blood tests revealed evidence of intestinal obstruction and normocytic anemia and neutrophilia. A laparotomy revealed persistent ascending and descending mesocolon, with a torsioned vascular pedicle of the spleen, resulting in splenomegaly and infarction. The surgeon successfully derotated the torsioned pedicle and performed a splenectomy. The patient had an uneventful postoperative course and was discharged without complications. CLINICAL DISCUSSION: This case could be asymptomatic and the diagnosis is incidental or it could be presented with ambiguous symptoms. The differential diagnosis of WS varies according to the clinical presentation and the associated complication. For instance, in the case of WS torsion and acute presentation, the differential diagnosis is ovarian torsion, acute appendicitis, and intestinal obstruction. Currently, surgery is the only suggested treatment option even in asymptomatic patients as well. CONCLUSION: This case of a Wandering Spleen is associated with a persistent ascending and descending mesocolon, suggesting that there may be certain risk factors. Therefore, we suggest making more research about wandering spleen in association with persistent mesocolon.