Wandering Spleen and Portal Hypertension: A Vicious Interplay

A 55-year-old woman presented with recurrent abdominal pain, a lump in her abdomen, and vomiting. In the previous 10 years, she required multiple hospital admissions for pain. Examination revealed pallor and a lump (20 cm × 15 cm) extending from left hypochondrium to left iliac region. Labs showed hemoglobin 7.8 g/dL, platelet count 5,100 cells/mm3, and serum protein/albumin 6.7/3.4 g/dL; the rest of her blood parameters were normal. Ultrasound showed heterogeneous liver echo-texture, ascites, and massive splenomegaly. Esophagoduodenoscopy showed grade 2 esophageal varices. Ascetic fluid examination showed high serum ascites albumin gradient (SAAG). Etiological evaluation for chronic liver disease (CLD) was negative. Computed tomography (CT) showed a homogeneously enhanced, massively enlarged spleen in the left lower abdomen. The vascular pedicle was long, stretched, and appeared coiled (whirl sign), suggestive of torsion (Figure 1). Features of CLD with portal hypertension (PHT) were seen, including diffuse atrophy of liver parenchyma, dilated portal vein, prominent perigastric collaterals, and ascites. The patient showed symptomatic improvement with conservative treatment