Table 1.

Summary table of wandering or ectopic spleen

Etiology	Congenital or acquired laxity of the suspensory splenic peritoneal ligaments.
Incidence	0.5% incidence in splenectomies. Only under 500 cases documented in published literature
Gender ratio	In children : M>F In adults: F>M
Age predilection	Females in reproductive age group ( 20 to 40 yrs)
Risk factors	In acquired cases: Multiparty, Trauma, Splenomegaly
Treatment	Splenopexy or splenectomy
Prognosis	Good prognosis if diagnosed promptly with early surgical intervention.
Complications	Torsion +/− Infarction of ectopic spleen, Rupture of ectopic spleen following trauma, injury to adjoining organs secondary to torsion (gastric volvulus, gastrointestinal obstruction, celiac axis occlusion, acute pancreatitis, pancreatic necrosis).
Imaging Findings	X-ray: Abdominal radiograph may reveal a well-defined radiodensity at the site of the ectopic spleen, especially if it is enlarged, displacing surrounding bowel loops.
	US: Absence of spleen in its normal location in the left hypochondrium. It is seen instead in its ectopic location, the spleen may be normal sized or enlarged. If complicated by torsion, the spleen may be normal in echogenicity/have altered echotexture/appear hypoechoic. Thrombosed, enlarged splenic vein in B-mode is hypoechoic in acute thrombosis and echogenic in subacute or chronic cases. Color Doppler imaging shows no flow in the splenic vein. Torsed splenic pedicle may be difficult to visualize by ultrasound. Splenic infarction, if present, may be focal or complete. Focal infarctions are seen as wedge shaped, sharply defined hypoechoic foci extending up to the splenic capsule. Completely infarcted spleen appears uniformly hypoechoic with altered echotexture. Free fluid may be present.
	CT : Complicated ectopic spleen is best assessed by CT. If complicated by torsion, whorled appearance of twisted pedicle is diagnostic. The degree of torsion corresponds to the number of twists the vascular pedicle has undergone. The thrombosed, engorged splenic vein does not show enhancement following contrast administration. Splenic infarction if present, are seen as non-enhancing, wedge shaped hypodensities in the arterial phase. Status of adjacent viscera can be assessed if they get tangled within the twisted pedicle. Most commonly pancreatic tail may be involved.
	MRI Splenic infarcts are seen as wedge shaped areas hypointense in T1 & T2WI, with no enhancement following contrast administration.
	Angiography Localizes the ectopic spleen and can diagnose splenic torsion. Invasive and not essential for diagnostic purposes.
	Scintigraphy Can localize the ectopic spleen Expensive and not widely available