Non-surgical Management of Splenic Volvulus and Infarction of Ectopic Spleen in an Adult Female: A Case Report

Ectopic spleen, or Wandering Spleen (WS), is a rare condition caused by laxity of splenic suspensory ligaments. While often asymptomatic, it may present with life-threatening complications such as torsion and infarction. We present a case of a 41- year-old female with a history of breast cancer who developed left-sided abdominal pain. Imaging confirmed an ectopic spleen in the pelvis resting on the urinary bladder, receiving its blood supply from the coeliac trunk. Computed Tomography (CT) also showed a well-demarcated area of non-enhancement at its inferior pole, along with twisting of the vascular pedicle associated with surrounding free fluid representing splenic volvulus and infarction. Enoxaparin 72 mg SQ BID was initiated for concurrent splenic vein thrombosis, and the patient was discharged on Rivaroxaban 20 mg PO OD. Over 16 months, serial imaging showed resolution of infarction and maintained splenic vascularity without surgical intervention. This case demonstrates that conservative management of WS with infarction may be viable with close monitoring and anticoagulation.