Other organs of the abdomen were normal. Magnetic resonance imaging of the abdomen and pelvis Absence of the spleen in the normal location. The spleen was seen in the lower right hemiabdomen, enlarged, with the size of 18.7×8.5×20.8 mm and sacral meningocoele.

CT angiography of abdominal vessels Splenic artery was divided by pancreatic artery, which was forwarded to the tail of pancreas giving it a “whorled appearance”, and from this level splenic vessels were thrombosed. Pancreas was moved forward without obvious radiological changes (Figures 2 and 3). Figure 2 Anteroposterior Angio-CT showing enlarged spleen in lower right hemiabdomen. Figure 3 Sagital Angio-CT showing size of spleen. Operative findings revealed a huge spleen in the pelvic area with torsion GSK-3 phosphorylation of the vascular pedicle starting at the tail of find more the pancreas (Figure 4). The characteristic “whirl sign” can be seen in the area of the splenic vascular pedicle, indicative of torsion (Figure 5). Other internal organs were normal. Figure 4 Huge spleen in right pelvic area. Figure 5 “Whirl sign” in the area of the splenic vascular pedicle, indicative of torsion. A total splenectomy was performed, as the organ appeared congested, it was likely infarcted and not likely to be salvageable (Figure 6). Figure 6 Spleen with diffuse

hemorrhagic and ischemic infarcts. The patient recovered well after the operation. Antibiotics, analgesics, plasma, blood, low molecular weight heparin, vitamins and triple vaccination (against pneumococcus, hemophilus influenza, and meningococcus) were given. He was discharged on oral anticoagulants because of heart disease. Histology revealed Etofibrate acute thrombotic changes in arteries and veins of the splenic hilum, with diffuse hemorrhagic and ischaemic

infarcts of the spleen. Discussion Wandering spleen is an uncommon clinical entity, which rarely affects children and adolescents. Discussion in the literature has been limited to case reports and small case series [1]. The condition is not hereditary. Congenital wandering spleen is a very rare randomly distributed birth defect characterized by the absence or weakness of one or more of the ligaments that hold the spleen in its normal position in the upper left abdomen. Instead of ligaments, the spleen is attached by a stalk-like tissue supplied with blood vessels (vascular pedicle). If the pedicle is twisted in the course of the movement of the spleen, the blood supply may be interrupted or blocked (ischaemia) to the point of severe damage to the blood vessels (infarction). Because there is little or nothing to hold it in place, the spleen “wanders” in the lower abdomen or pelvis where it may be mistaken for an unidentified abdominal mass.