Gastric outlet obstruction secondary to wandering spleen.

A 40-year-old healthy woman developed acute upper abdominal pain, sharp and unremitting, while eating lunch. The pain was followed by nausea and vomiting. On physical examination, the patient was uncomfortable, although in no acute distress. Her vital signs were stable, and her abdomen was softly distended, with mild epigastric tenderness. No masses were palpable, and rectal exam was guaiac negative. A nasogastric tube was inserted and drained a moderate amount of clear gastric fluid. Significant laboratory values were: white blood cell count, 19,300/μL; hemoglobin, 11 g/dL; amylase, 78 U/dL; and lipase, 330 U/L. A plain upright radiograph of the abdomen showed a dilated stomach and no free air. An abdominal computed tomography scan with oral and intravenous contrast was performed and revealed the spleen to be medial to a distended stomach, with no passage of gastric contrast beyond the stomach (Figure). These findings led to a diagnosis of gastric outlet obstruction caused by a wandering spleen. During an operation, it was found that the spleen and the tail of the pancreas had migrated through a defect in the greater omentum near the gastric fundus into the lesser sac. The proximal stomach was massively distended and edematous with petechiae. It was constricted at the junction between the body and the antrum. The pancreatic tail was edematous as well. There was no evidence of any splenocolic, splenorenal, or splenophrenic ligament. A splenectomy was carried out. A gastropexy was also performed by means of a decompressing gastrostomy. Postoperatively, the patient received pneumococcal and Hemophilus influenzae vaccines, and the remainder of her 5-day hospital course was uneventful. At the 3-month and the 1-year follow-up examinations, she remained asymptomatic.