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Fell From Scaffolding. Having Pain Under Lower Rib. X-ray Normal. Worried For Spleen Problem
Question: My son is 17 years old. Has been waking up more and more frequently with pain just under the left lower rib. It has been going on for approx. 8 years and he now is up most nights because of it. He feels like if he pushes up under the rib, as if pushing something out of the way, and holds it there for a while it helps. It gets worse when he catches any kind of bug. He has been to his family doctor who took X-rays (found no broken rib) and was given exercises to help. He has been faithful about the exercise routine but it's only getting worse. He did have a fall off of a scaffold about a month or so before he first mentioned the pain. He thought it was his mattress so he has slept in every bed in the house but no difference. He said he notices it mostly when sleeping on his left side. Since the family doctor didn't have suggestions I started researching anything I could find and everything seems to point to wandering spleen. Unfortunately, this being so rare I haven't been able to find much information nor the type of doctor who may be able to help him get to the bottom of this painful experience. My older son is a critical care pediatrician and said he had heard of it but hadn't seen a patient with it and suggested maybe an MRI. I hate going into the family doctor as if I know what I am talking about because I don't. I am only trying to find a reason for my son's pain. Any suggestions?
Hi XXXXXXX,
I will try to help. I see you are concerned with an issue with the spleen, which is the area where you describe your son's pain. First of all, as you mentioned this is very rare, and I have never seen anybody with this syndrome, however any major issues with the spleen can be easily picked up with an abdominal ultrasound, or if possible to obtain then a CT scan or MRI of the abdomen.
The fact that the pain started after a fall, would make me think there is something muscular or trauma to the spleen. Therefore I would suggest at least an abdominal ultrasound to have an idea if anything is going on.
If the spleen is normal (not enlarged, normal color and consistency on imaging without evidence of hematomas), then I would consider to take a look at the pancreas (best seen on CT or MRI. Ultrasound not great to look at the pancreas). If there is an issue with the "tail" of the pancreas (like a cyst, or just inflammation of the pancreas), the pain can be referred to the "left upper quadrant of the abdomen" or just underneath the rib.
In the meantime, he can try an anti-inflammatory or muscle relaxant and see if this helps with the pain, which would favor that the pain is musculoskeletal in origin.
Other problems to be considered are colon or small bowel spasms, abdominal vessel problems (causing "ischemia" or lack of blood supply to certain organs), however these problems are usually related to food intake, bowel movements, etc.
Hope that helped.
I will try to help. I see you are concerned with an issue with the spleen, which is the area where you describe your son's pain. First of all, as you mentioned this is very rare, and I have never seen anybody with this syndrome, however any major issues with the spleen can be easily picked up with an abdominal ultrasound, or if possible to obtain then a CT scan or MRI of the abdomen.
The fact that the pain started after a fall, would make me think there is something muscular or trauma to the spleen. Therefore I would suggest at least an abdominal ultrasound to have an idea if anything is going on.
If the spleen is normal (not enlarged, normal color and consistency on imaging without evidence of hematomas), then I would consider to take a look at the pancreas (best seen on CT or MRI. Ultrasound not great to look at the pancreas). If there is an issue with the "tail" of the pancreas (like a cyst, or just inflammation of the pancreas), the pain can be referred to the "left upper quadrant of the abdomen" or just underneath the rib.
In the meantime, he can try an anti-inflammatory or muscle relaxant and see if this helps with the pain, which would favor that the pain is musculoskeletal in origin.
Other problems to be considered are colon or small bowel spasms, abdominal vessel problems (causing "ischemia" or lack of blood supply to certain organs), however these problems are usually related to food intake, bowel movements, etc.
Hope that helped.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Molina. Just a couple follow-up questions: If, going on an assumption that it is an acquired wandering spleen problem, could the fall have torn one of the ligaments holding the spleen in place? That seems theoretically possible (in my limited understanding) causing the spleen to 'seep' out of place while lying down and enlarged when he is sick thus causing the pain. Since it only shows up while sleeping or sick could that mean that it moves back into normal position and is not twisted? If that were the case, would anything show up on a scan or MRI because they would be done during the day while he isn't having pain? The second question is; would it be enlarged even when he isn't having pain? The reason I am going here is because he doesn't seem to have pain during the day or while moving around during sports, nor any problems with bowels. If this were a pain that showed up sporadically I wouldn't be thinking in this direction. I am all for having the scan done but if it is in place during the scan, would anything show up? Would you recommend an XXXXXXX medicine doctor versus his family practitioner at this point? Thank you again. XXXXXXX
I have never heard of the spleen moving out of place after a trauma. If the spleen was to move from place after a big trauma, it would have bled significantly and he would have ended up in the hospital requiring blood transfusions and surgery. The reason being that this is a highly vascular organ, and if moved it would rip all the vessels and cause a major bleed.
If the spleen is enlarged for some other reason then it will show up on imaging studies. This is not intermittent.
Again I believe an ultrasound of the abdomen is indicated, but the most likely source of the pain is a musculoskeletal problem (either pulled muscle, inflammation of rib joints, etc). I think a family practitioner can handle this problem, however an internist is for sure capable of handling it.
Hope that helps.
If the spleen is enlarged for some other reason then it will show up on imaging studies. This is not intermittent.
Again I believe an ultrasound of the abdomen is indicated, but the most likely source of the pain is a musculoskeletal problem (either pulled muscle, inflammation of rib joints, etc). I think a family practitioner can handle this problem, however an internist is for sure capable of handling it.
Hope that helps.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Molina. I appreciate your replies. I will make an appointment soon to get this started. Your answers have helped me. Have a great weekend. XXXXXXX
You are welcome, have a great weekend!
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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