Surgeon puts boy’s “wandering spleen” back in its place

By Maureen Gilmer, Riley Children’s Health senior writer, mgilmer1@iuhealth.org

Internal organs just don’t go missing, do they?

That’s what Casey and Sara Pinnell wondered when their 7-year-old son, Easton, was diagnosed with a wandering spleen.

That’s right, the boy’s spleen had seemingly disappeared from its rightful place in the upper left side of his abdomen, next to his stomach.

When Riley Children’s Health doctors delivered that news to Easton’s parents, his dad, a middle school principal, couldn’t help but offer up a weak joke: “We haven’t noticed it sitting around the house or anything.”

It took a while to solve the mystery amid a couple of false starts, but today, Easton is doing well, and, after surgery, his spleen is back where it belongs.

Wandering spleen is a very rare condition, occurring in less than 0.5% of the population and typically caused by a weakening or absence of supporting ligaments that hold the spleen in place. In Easton’s case, the first signs of trouble were severe abdominal pain and an inability to vomit.

His parents took him to the emergency department at a hospital near their Paris, Illinois, home, where doctors found his blood sugar levels extremely elevated and suggested he might be suffering from diabetes. Lacking a pediatric care team, they sent him by ambulance to Riley, 100 miles away.

That was the last week of May, at the tail end of baseball season. Easton is an active, soon-to-be second-grader who loves all things sports and is “extremely tough,” his dad said. He hadn’t exhibited any of the signs his parents thought were associated with type 1 diabetes, such as increased thirst, fatigue and weight loss.

Tests at Riley confirmed he was not suffering from diabetes, so the gastroenterology team entered the picture, thinking perhaps the boy had pancreatitis and ordering a CT scan. That’s when doctors realized that a previous scan on file showed his spleen in the proper place, but a new scan indicated it had moved.

“A wandering spleen is very rare,” said Riley surgeon Dr. Troy Markel. “Normally, the spleen sits on the left side of the abdomen under the rib cage. In Easton’s case, it had flipped up onto the stomach, and the weight of the spleen obstructed drainage of his stomach.”

It was an unusual condition, to say the least, one that most in the medical field have not seen before.

“I think it was kind of a shock to everybody,” Casey Pinnell said.

Doctors originally thought Easton had a hole in the diaphragm muscle that was allowing the spleen to move, so the plan was to repair that laparoscopically in the operating room.

But about two hours into the procedure, Dr. Markel came out of the OR to speak with Easton’s parents, letting them know that the fist-sized organ, which helps support the immune system, once again had moved and they needed to open Easton up to better understand what was happening.

The reason the child’s spleen was able to wander was because he had something called diaphragmatic eventration, or “a big floppy diaphragm muscle,” creating a space in the upper part of his abdomen to allow the spleen to move around.

“We discovered in the OR that there was no hole in the muscle, but rather the diaphragm was just floppy and ballooned up into his chest cavity more than normal,” Dr. Markel said. “We tightened the diaphragm, almost like a ‘tummy tuck’ for the diaphragm, to close down that space so the spleen didn't have any room to flop around anymore.”

After the May 30 surgery, Easton was up walking by the next day and said he was hungry enough to “eat 4,000 pizzas.” He settled for a hospital cheeseburger first, followed by a slice of pizza. Three days later, he was back home in Illinois, ready to get on with the life of a 7-year-old.

That meant swimming, fishing and playing baseball, even if his parents did try to hold him back at first.

“It was a fight to keep him from doing things that we thought he shouldn’t be doing,” Casey said during a return trip to the Indianapolis area last weekend for a softball tournament for one of Easton’s two sisters.

While waiting for his sister’s game to begin, Easton proudly showed off his abdominal scar and gave a shout-out to his favorite nurse, Ashley, on Riley’s eighth floor.

“All of the nurses were really awesome,” Casey said.

The first time Easton was back on the baseball field, two weeks out from surgery, his dad didn’t allow him to bat or run the bases, but he put him in the outfield, instructing him to only pick up a ball hit right to him and throw it to second base.

“And of course, the first ball that’s hit went all the way to right field, he sprinted across the field, picked it up and threw it all the way to the pitcher’s mound from the right field fence,” Casey said, shaking his head.

That’s about when Easton’s parents realized they could no longer keep him in a protective bubble.

Dr. Markel has cleared Easton to resume his normal activities, so he will be playing flag football in the fall and basketball in the winter.

“I really don’t have any worries at this point,” said Easton’s mom, a second-grade teacher. “I think we’ve seen enough that we’ve started to calm down.”

But she’ll be able to keep a close eye on him at home and school. When classes resume in mid-August, he will be right across the hall from her in the school’s other second-grade classroom.

Photos submitted and by Mike Dickbernd, IU Health visual journalist, mdickbernd@iuhealth.org