A 20-year-old woman went to doctors in Ankara, Turkey, with abdominal pain. Imaging showed a large, solid mass in her pelvis, and her doctors initially suspected an ovarian germ cell tumor, a type of cancer that often affects young women.
Her scans held one more strange finding. Her spleen was missing from its usual spot in the upper left part of the abdomen.
At surgery, the explanation became clear. The pelvic mass was her own spleen, sitting far from its normal position, and tissue analysis confirmed it. Gynecologic oncologists at Etlik City Hospital reported the case in August 2026 in the Journal of Obstetrics and Gynaecology Research.
The Missing Organ Was the Clue
The authors write that imaging before surgery "demonstrated absence of the spleen in the left upper quadrant and a solid pelvic mass." Their main message is that doctors should consider a wandering spleen when evaluating pelvic masses in young women, "particularly when the spleen is not visualized in its normal location."
That advice is aimed squarely at gynecologists. A solid pelvic mass in a woman in her twenties usually raises concern about the ovaries. According to the American Cancer Society, dysgerminoma, a type of germ cell tumor, usually affects "women in their teens and twenties." Germ cell tumors make up less than 2% of ovarian cancers, and more than 9 in 10 patients survive at least five years after diagnosis. Some types, such as yolk sac tumors, raise a blood marker called alpha-fetoprotein.
The distinction matters because the two conditions are handled so differently. A suspected ovarian cancer leads to cancer surgery, while a wandering spleen raises a different question: whether the organ can be saved.
An Organ Without Its Anchors
Normally, ligaments hold the spleen in the upper left abdomen. According to the National Institutes of Health's Genetic and Rare Diseases Information Center, a wandering spleen lacks one or more of these ligaments. The condition can be present from birth or acquired later, for example after injuries or conditions that weaken the ligaments, and it is not hereditary. The National Organization for Rare Disorders (NORD) explains that the spleen is then attached only by a stalk of tissue carrying its blood vessels, which lets it move.
The condition is rare. NORD says fewer than 600 cases have been reported worldwide, and the true incidence is unknown and may be underestimated. A 2013 report in the World Journal of Emergency Surgery notes that wandering spleen accounts for less than 0.25% of splenectomies.
The patient fits the typical profile. NORD notes that adult cases are usually reported between ages 20 and 40, with about seven women for every man. Possible explanations include multiple pregnancies, connective tissue disorders, and trauma. Children make up about a third of cases, and boys and girls are affected equally. The Cleveland Clinic adds that the condition may develop after pregnancy, which loosens the ligaments.
Many patients have no symptoms, according to NORD, and the condition is sometimes found by chance on imaging. Others notice a lump in the abdomen or pelvis. The Cleveland Clinic notes that the spleen can "twist and untwist" on its stalk, causing recurring belly pain.
Torsion Is the Real Danger
The main risk is torsion. When the spleen twists on its blood supply, blood flow can be cut off. The Ankara authors note that a wandering spleen "may lead to serious complications such as torsion and infarction," meaning tissue death. Because symptoms are vague, they write, "diagnosis can be challenging and imaging plays a crucial role."
Treatment depends on whether the spleen is still healthy. The 2013 emergency surgery report calls splenopexy, fixing the spleen back in place, "the treatment of choice for a noninfarcted wandering spleen." Preserving the spleen, that report notes, avoids the risk of overwhelming infection after splenectomy. Even so, the Cleveland Clinic says removal remains the most common treatment overall, and it is generally needed when the spleen has lost its blood supply.
That choice has lasting consequences, because people without a working spleen face a higher risk of severe infections. The CDC's adult immunization schedule recommends pneumococcal, meningococcal, and Hib vaccines for people with asplenia, with the Hib dose given preferably at least 14 days before a planned splenectomy.
One Case, a Broader Lesson for Pelvic Masses
A single case cannot show how often wandering spleens are mistaken for ovarian tumors. The authors themselves call the condition "a rare clinical entity." The report's value lies in the specific clue it highlights.
Young women with a pelvic mass usually do have a gynecologic cause. But if scans also show no spleen in the upper left abdomen, that finding deserves attention before surgery. Women who notice a persistent abdominal or pelvic lump, or sudden severe abdominal pain, should get medical care promptly, since sudden pain can be a sign that an organ has twisted.
Key Questions Answered
What happened?
A 20-year-old woman with abdominal pain had a large pelvic mass that doctors first suspected was an ovarian germ cell tumor. At surgery, it turned out to be her spleen.
What is a wandering spleen?
A spleen that lacks one or more of the ligaments that normally hold it in place. Attached only by a stalk of blood vessels, it can move around the abdomen or into the pelvis.
How common is it?
It is rare. Fewer than 600 cases have been reported worldwide, and it accounts for less than 0.25% of spleen removals.
What clue pointed to the spleen?
Imaging showed no spleen in its usual spot in the upper left abdomen, along with a solid pelvic mass.
Why is a wandering spleen dangerous?
It can twist on its blood supply. That can cut off blood flow and kill the tissue.
How is it treated?
A healthy spleen can often be fixed back in place. Removal is common, especially when the spleen has lost its blood supply, and vaccines are then recommended to lower infection risk.
Published by Medicaldaily.com
