Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction

Abstract

Background Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction. Methods From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized. Results There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4–170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient. Conclusions Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen.

A rare case of wandering spleen with its unreported associations: case report and literature review

“…Wang et al, in their case series, suggested the role of preoperative thrombocytosis as a predictor of splenic infarction. 10 A similar scenario was seen in our study also, where thrombocytosis was associated with splenic infarction. It is too premature to say that; thrombocytosis is a marker of splenic infarction.…”

“…7 Wang et al also suggested that early abdominal cross-sectional contrast imaging (especially contrast CT) should be performed to make an early and correct diagnosis, especially in children with abdominal pain and abdominal mass. 10 Another rarely used modality for the acute abdomen is magnetic resonance imaging which may show splenic infarction as peripheral wedgeshaped defects exhibiting reduced signal intensity on both T1-and T2-weighted images without contrast enhancement. 11 The degree of torsion, according to literature, ranges from 90° to 3600 o .…”

Radiologic Findings of Single Accessory Splenic Infarction in a Patient with Accessory Spleens in the Abdominal Cavity: A Case Report

“…Involution or atrophy are the natural advancements of an infarcted accessory spleen [21]. Early diagnosis and timely surgical intervention are important in order to preserve the spleen [40]. It is essential to address any modifiable risk factors and monitor the patient for possible symptoms, conducting regular follow-ups to detect early signs of complications.…”

Splenic Torsion in Heterotaxy Syndrome with Left Isomerism: A Case Report and Literature Review

“…Surgical intervention and conservative management are the two main splenic torsion treatment options. Splenectomy is the main choice of treatment for splenic torsion, but the spleen can also be preserved using detorsion, splenopexy, and an autotransplant [ 21 ]. More than 50% of patients who chose conservative management require subsequent surgery.…”