NEJM: Spleen Displacement - Case Report

The patient, a 36-year-old woman, went to the emergency department for a day because of abdominal pain and vomiting.
she suffers from ulcerative colitis and cirrhosis of the liver caused by primary sclerosis bileitis, and her surgical history includes a full colonectomy, a gallbladder excision and an appendectomy.
physical examination found diffuse abdominal pain.
laboratory examination found lipase levels of 682 IU/L (reference range 5 to 50).
the lower right quadrant (as shown by the A-star) and the tail of the pancreas at the bottom and right side of the spleen, according to a computer fault scan of the abdomen.
Two days before this visit, patients had been routinely screened for hepatocellular carcinoma by magnetic resonance gallbladder pancreatic tube anthosis, which showed that the spleen was located on the left side of the abdomen (as shown by the Asterisk B) and that the pancreas was normal and no gallstones were seen.
the spleen is a rare disease caused by sagging ligaments in the spleen.
the movement of the spleen, this can lead to distortion of structures inside or near the spleen door, including the tail of the pancreas, which can lead to acute pancreatitis.
clear treatment for this condition is a spleen excision.
patient received treatment for extra gastrointestinal pain control and rehydration, abdominal pain and vomiting were relieved.
the spleen removal was delayed because the patient was undergoing a liver transplant assessment.