Splenic torsion with involvement of pancreas and descending colon in a 9-year-old boy

Abstract

Splenic torsion is an uncommon condition becoming clinically apparent when the spleen twists or rotates around the organ’s vascular pedicle. In the case of a wandering spleen the organ is only attached to an elongated vascular pedicle while the peritoneal attachments are absent. However, splenic torsion could also occur in patients with abnormal laxity of the splenic peritoneal attachments. We report a case of a splenic torsion due to absence of splenic ligaments with pancreatic volvulus and partial involvement of descending colon in a 9-year-old boy.

Wandering spleen with splenic torsion in a toddler

“…[ 4 ] Although WS has been described from neonates to elderly patients in the 1980s, it has a 2-peak incidence that mainly occurs among children aged <10 years and women of reproductive ages (average: 25.2 years) among adults. [ 5 , 6 ] In pediatrics, most WS cases are seen in children <1 year old, which is 2.5 times more common in boys than in girls, [ 7 ] and the condition may have equal incidence rates in both sexes within the first 10 years of life. [ 8 ] After the first decade, WS predominantly occurs among females compared to males, with a ratio of 7:1.…”

“…[ 21 ] Beside the diagnosis of WS, the viability of the spleen, involvement of other nearby organs, and torsion degree, which can be defined by identification of the whirl sign and the hilar color Doppler flow, are able to be assessed via ultrasonography. [ 6 ] Abdominal CT scan is another common examination that is routinely performed to aid the diagnosis and assessment of WS. Most common findings in CT scan include an empty splenic fossa and a translocated spleen.…”

“…Most common findings in CT scan include an empty splenic fossa and a translocated spleen. [ 6 ] Contrast-enhanced CT angiography are helpful for a precise assessment of spleen perfusion, which is meaningful for surgical management. However, the toddlers with abdominal pain may have trouble in finishing a CT scan, let alone the invasive CT scans that require the injection of contrast material.…”

“…[ 2 ] The choice of a surgical option is made according to the viability of the spleen; if the spleen shows reperfusion after manual detorsion, laparoscopic splenopxy may be offered, which is less invasive and can preserve the immunological function of the spleen and prevent postsplenectomy sepsis in children. [ 6 ] Various laparoscopic spleenopxy techniques have been described in literature, and their common purpose is to reposition and fix the spleen to its normal anatomical position. [ 23 ] Total splenectomy, partial resection via laparoscopy, or open surgery is recommended for patients with WS that have complications including splenic infarction, rupture, hemorrhage, thrombosis, splenomegaly, and compression of other organs.…”

Bazo errante infartado y vólvulo de cola de páncreas en un paciente con hernia de Grynfelt-Lesshaft concomitante

“…El tratamiento quirúrgico del bazo errante depende del contexto clínico y puede variar desde solo esplenopexia hasta esplenectomía en caso de infarto esplénico. Si existe compromiso de la cola del páncreas, la pancreatectomía distal es el procedimiento de elección 1,3,8,10,11 . La asociación de bazo errante infartado con afección de otras estructuras es inusual, por lo que encontrar un vólvulo pancreático es sumamente raro 10,11 .…”