Non-operative management of a rare diagnosis of splenic torsion in a child with a history of giant omphalocele: a case report and literature review

Abstract

BackgroundSplenic torsion is rare and as a result the appropriate management is unclear. While there has been a shift towards splenectomy and laparoscopic splenopexy, we present a successful case of non-operative management of splenic torsion in a patient with a history of a giant omphalocele.Case presentationA 3 year-old female presented with a three-day history of abdominal pain, fever and non-bloody emesis three and a half years after repair of her giant omphalocele. Abdominal radiographs and ultrasound demonstrated migration of the spleen and a subsequent computerized tomography scan confirmed splenic torsion and an infarcted spleen. Given her late presentation, she was successfully managed with observation, analgesia, immunization against capsulated organisms and daily penicillin prophylaxis with excellent outcome at 19 months follow-up. A review of the literature revealed that splenic torsion is rarely managed non-operatively. Rarer still is the occurrence of splenic torsion following a history of omphalocele.ConclusionAlthough rare, splenic torsion should be considered in a child with a history of omphalocele presenting with abdominal pain. Non-operative management of an infarcted spleen can be a safe treatment option to avoid surgery in complex patients.

Surgical Management of a Volvulus of a Wandering Spleen Associated with a Volvulus of the Small Intestine

“…The management of WS may be either nonsurgical or surgical. Conservative nonoperative management is reserved for patients with mild symptoms and no complications that are considered high-risk surgical candidates [32]. This alternative is controversial since it has been noted that 65% of patients with WS undergoing nonoperative treatment have recently developed complications such as splenic torsion requiring surgical treatment [33].…”