Case ReportTorsion of huge wandering accessory spleen. Case report and review of literature

•Wandering accessory spleen of giant sizeis a rare clinical presentation of a common disease that carry significant morbidity and mortality.•To highlight the awareness of the disease and familiarity of its typical radiological findings especially in the acute setting.•To review the literature and describe the different surgical options according to the size and expertise.

IntroductionAccessory spleens are found in 10-15% of the population, and are even more prevalent in patients with hematological disorders (Rudowski, 1985). It infrequently may become symptomatic due to torsion, spontaneous rupture or hemorrhage which may lead to death. Torsion of an accessory spleen is extremely rare, and requires prompt medical attention [2] (Coote et al., 1999).Presentation of caseWe report the case of a 27-year-old Mediterranean lady with thalassemia trait, who presented to the emergency department with an acute surgical abdomen due to torsion of a giant accessory spleen, measuring 13 cm. She was diagnosed with the aid of ultrasound and computed tomography (CT) scan and was treated surgically through resection of the spleen.Discussion and conclusionTorsion of an accessory spleen is not common, and is the surgical indication in about 0.2-0.3% of splenectomies (Mortele et al., 2004). It has variable clinical presentations, and is a difficult preoperative diagnosis due to lack of specificity of symptoms. Accessory spleens are usually smaller than 3 cm, with few cases being reported as larger than 10 cm larger accessory spleens have a higher rate of torsion. Knowledge of this pathology, and familiarity with its radiological findings are fundamental to accurately diagnosing and manageming this challenging condition.