Year: 2026 | Month: August | Volume: 13 | Issue: 8 | Pages: 374-378
DOI: https://doi.org/10.52403/ijrr.20260836
Tropical Splenomegaly Presenting as Tummy Crisis
Ayush Choudhari1, Ramesh M Tambat2
1Post Graduate, Department General Surgery, 2HOD & Professor,
Sapthagiri Institute of Medical Sciences & Research Center, Bengaluru, Karnataka, India
Corresponding Author: Dr. Ayush Choudhari
ABSTRACT
Massive splenomegaly, defined as splenic enlargement extending into the pelvis, crossing the abdominal midline, or weighing over 1000 g, is an uncommon clinical finding with a broad differential encompassing hematologic, hepatic, and infectious etiologies. Tropical or hyperreactive malarial splenomegaly, thought to arise from an aberrant immune response to recurrent malarial infection, is a rare cause of chronic massive splenic enlargement in endemic regions. Splenic torsion complicating such enlargement is an exceedingly rare surgical emergency, and its co-occurrence with tropical splenomegaly has not been previously documented in the literature.We report the case of a 47-year-old who woman presented with a four-month history of progressive fatigue and was found to have severe anemia requiring transfusion. She subsequently developed acute diffuse abdominal pain with recurrent vomiting and abdominal distension. Examination revealed a markedly distended, tender abdomen with absent bowel sounds and a massive, palpable splenic mass extending to the right iliac fossa. Contrast-enhanced CT demonstrated a devascularized, torsed, massively enlarged spleen causing mechanical small bowel obstruction. After resuscitation, she underwent emergency exploratory laparotomy, which revealed an absence of the normal splenic suspensory ligaments — consistent with a wandering spleen — with associated torsion. Detorsion followed by splenectomy was performed, yielding a spleen weighing 2100 g. Postoperative recovery was uneventful, and subsequent workup established a diagnosis of tropical splenomegaly as the underlying cause of splenic enlargement. This case highlights an unusual presentation in which an underlying tropical splenomegaly predisposed to splenic torsion in a wandering spleen, precipitating acute small bowel obstruction — a combination without prior report in the literature. Clinicians in malaria-endemic settings should maintain a high index of suspicion for splenic torsion as an acute surgical complication in patients with massive splenomegaly of tropical origin.
Keywords: Massive splenomegaly; Wandering spleen; Splenic torsion; Tropical splenomegaly; Hyperreactive malarial splenomegaly; Small bowel obstruction; Splenectomy
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