BackgroundWandering pelvic spleen is an uncommon radiologic diagnosis in which presentation can be quite dramatic. Previous case reports and literature reviews focused on the use of ultrasound as an initial study for detecting abnormally placed abdominal viscera. The usefulness of helical computed tomography for reaching a definitive, cost-effective diagnosis is vividly illustrated in this case.Case ReportA 53-year-old woman was referred for evaluation of a pelvic mass detected during physical examination. Bimanual examination revealed a firm, somewhat tender, midline pelvic mass in which its long axis was oriented along an anterior-posterior plane. Because of the patient's complicated surgical history, contrast-enhanced helical computed tomography of the abdomen and pelvis were requested, which showed the liver to be markedly enlarged and an obliquely oriented spleen.DiscussionLigamentous laxity or congenital incomplete fusion of the dorsal mesogastrium may allow the spleen to migrate within the peritoneal cavity. This is called a wandering or ectopic spleen. Wandering spleens are quite uncommon.The condition of this patient's pelvic spleen was thought to be related to previous colectomy for ulcerative colitis. Patients with displaced spleens are at significant risk for rupture of the spleen after trauma, leading many to advocate elective splenopexy or surgical resection.SummaryBecause her lifestyle is relatively sedentary, the patient decided not to undergo surgery and was counseled to seek immediate attention after abdominal or pelvic trauma. The patient was referred back to the local health maintenance organization and the local medical doctor for evaluation of hepatomegaly.