Abdomen / Pelvis for Friday, April 11th, 2025

Contributed by Children's Mercy Hospital/University of Missouri-Kansas City Medical School
Olivia Biernacki, and Julie Steinberg.

History

5-year-old boy presenting with acute onset of nausea and abdominal pain. 

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Question

What is the most likely diagnosis?

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Correct answer

Splenic Torsion

Discussion

A 5-year-old boy presented with acute onset of left-sided abdominal pain. CBC was notable for anemia (Hb 10.7) and thrombocytosis (platelets 1307).

CT demonstrated splenomegaly with abnormal rotation of the spleen within the left upper quadrant. The enhancement pattern of the spleen was abnormal with diffuse hypo-enhancement of the parenchyma and thin capsular enhancement. CT additionally demonstrated non-opacification of the splenic artery and vein at the splenic hilum. Ultrasound confirmed reduced perfusion of the spleen on power doppler ultrasound. Based on the clinical history and imaging, the diagnosis was made of splenic torsion with ptotic/wandering spleen. 
Wandering spleen is a rare condition in which the spleen is ectopically located in the abdomen. This can be secondary to absent or lax ligaments or long pedicle. The location can vary from ectopic rotation to location of the spleen within the pelvis.  

The most common complication of a wandering spleen is splenic torsion, in which the spleen twists upon the vascular pedicle resulting in diminished or absent blood flow and obstruction of venous drainage. This can present with acute abdominal pain. In the setting of acute abdomen with splenic infarction, a splenectomy is often indicated. In this case, the patient's symptoms resolved and the patient was managed conservatively in the hospital, with plans for elective splenopexy in the future.

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References

  • Safioleas MC, Stamatakos MC, Diab AI, Safioleas PM. Wandering spleen with torsion of the pedicle. Saudi Med J. 2007;28:135–136 Misawa T, Yoshida K, Shiba H, Kobayashi S, Yanaga K. Wandering spleen with chronic torsion. Am J Surg. 2008;195:504–505. doi: 10.1016/j.amjsurg.2006.08.083.