Wandering accessory paracervical spleen undergoing torsion in pregnancy: A challenging diagnosis and management

Accessory spleens are usually located at the splenic hilum or pancreatic tail; ectopic pelvic sites are extremely uncommon. Wandering spleen, in contrast, results from laxity or absence of splenic ligaments and predisposes to torsion. An accessory wandering spleen, in which an ectopic accessory spleen is supplied by a long pedicle that permits abnormal mobility, represents an exceptional combination of both conditions. Its occurrence during pregnancy is extraordinarily rare. Pregnancy might predispose to torsion through hormonal and mechanical factors that increase ligamentous laxity and alter abdominal organ positioning.2 Clinical manifestations are nonspecific, making diagnosis difficult and often delayed until complications occur. While cases of wandering spleen in pregnancy have been described,3 only one prior report has detailed an accessory wandering spleen in the pelvis during gestation.4 We present the first case of torsion of an accessory wandering spleen diagnosed in a primigravida and treated with laparoscopic splenectomy in the third trimester. We emphasize the diagnostic role of multimodal imaging, review the literature, and discuss both surgical and obstetric considerations.