A 15-year-old girl arrived at a hospital in Morocco after three days of abdominal pain. A CT scan found the explanation in an unexpected place. Her spleen was missing from the upper left abdomen and instead sat in the lower right abdomen, extending into her pelvis and pressed against her bladder and uterus.
Radiologists at Mohammed VI University Hospital in Oujda reported the case in Radiology Case Reports in June 2025. They diagnosed a wandering spleen, a rare condition in which the ligaments that normally anchor the spleen are missing or loose, letting it travel through the abdomen.
She recalled a similar bout of abdominal pain about a year earlier that went away without medical care.
An Organ Hanging by Its Blood Vessels
The spleen normally sits under the left ribs, held there by ligaments. Without them, it hangs from its blood vessels, a stalk called the vascular pedicle. In this girl, CT showed an enlarged spleen, about 17 centimeters long, with a long, dilated stalk that was twisted into a “whirl sign.”
That stalk is the danger. When a free-floating spleen rotates, it can twist its own blood supply shut, a complication called torsion that can kill the organ. Italian radiologists writing in a 2024 Radiology Case Reports paper explained that a mild twist may cause chronic pain from congestion, a moderate one can cause intermittent pain as the stalk twists and untwists, and a severe one causes the spleen tissue to die. The whirl sign of a twisted stalk is specific for torsion on CT, according to a 2015 case report in the International Journal of Clinical and Experimental Medicine.
Despite the twist, the girl’s spleen still had a working blood supply, so the scan ruled out tissue death. Because of the risk of further torsion, her doctors planned urgent surgery to remove it. The report does not describe the operation or her recovery.
That choice stands somewhat apart from the authors’ own review of the literature, which says fixing a healthy spleen back in place, called splenopexy, is generally preferred because it preserves the organ’s immune function, while removal is reserved for tissue death or irreversible loss of blood flow. The authors also noted that about 60% of ectopic spleen cases come with abdominal pain or a mass, 40% cause no symptoms, and removals for this condition make up fewer than 0.25% of all spleen removals.
A String of Teen Cases With Twisted Spleens
Other teenage girls described in recent reports were not as fortunate.
In China, a 17-year-old with five days of worsening abdominal pain had a pelvic spleen with a 360-degree twist and tissue death, according to a 2025 report in Frontiers in Medicine. Surgeons removed it through an open operation. Afterward, her platelet count climbed, and doctors gave her blood thinners and then aspirin for about two months to lower the risk of clots.
In South Korea, a 15-year-old’s congested spleen, 18 centimeters long, had twisted three full turns and dragged her small bowel into a blockage, according to a 2018 report in The Korean Journal of Gastroenterology. Surgeons removed it, and two weeks later she received pneumococcal and meningococcal vaccines to lower her risk of serious infection.
A 16-year-old girl with six months of recurring, severe pain under her left ribs also needed her spleen removed because of torsion and tissue death, according to a 2025 report in the International Journal of Surgery Case Reports. Its authors wrote that splenopexy is the preferred choice when there is no tissue death, enlargement, or overactivity of the spleen.
Saving the spleen is possible when the organ is still viable. Doctors in the United Arab Emirates described three girls in a 2025 BMC Pediatrics report. A 13-year-old needed removal after attempts to untwist her spleen failed, but surgeons fixed the spleens of a 10-year-old and a 3-year-old back in place.
Easy to Mistake for Something Else
Wandering spleen is rare enough that few doctors suspect it. The National Organization for Rare Disorders says the first case was reported in 1667 and fewer than 600 have been documented worldwide, though the true number is unknown. About a third of cases occur in children, and pregnancy is thought to loosen the supporting ligaments, making the acquired form more common in women who have had children.
In girls and young women, a spleen in the pelvis can be mistaken for an ovarian or uterine problem. MedicalDaily previously reported on a 20-year-old woman in Turkey whose pelvic mass was suspected to be an ovarian germ cell tumor before surgery revealed her own wandering spleen.
These are individual case reports, and they cannot show how often wandering spleens twist or which treatment works best.
Recurrent or severe abdominal pain in a child or teen deserves a medical evaluation, even if an earlier episode went away. Sudden severe pain, vomiting, fever, or a swollen, tender abdomen needs emergency care. Anyone who has had a spleen removed should ask their doctor about recommended vaccines.
Key Questions Answered
What happened to the girl?
After three days of abdominal pain, a CT scan showed her enlarged spleen had moved into her lower right abdomen and pelvis, next to her bladder and uterus.
What is a wandering spleen?
A rare condition in which missing or loose ligaments let the spleen move away from its normal spot under the left ribs.
Why is it dangerous?
The spleen hangs from a long stalk of blood vessels that can twist, cutting off blood flow and causing tissue death.
Had her spleen twisted?
Its stalk showed a twist, but the spleen still had a working blood supply. Doctors planned surgery to remove it because of the risk of further torsion.
How rare is it?
Fewer than 600 cases have been reported worldwide since 1667, according to NORD.
When should a child’s belly pain be checked?
Recurrent or severe pain should be evaluated. Sudden severe pain, vomiting, fever, or a swollen abdomen needs emergency care.
Published by Medicaldaily.com
