Splenic torsion: a case report

Abstract

Introduction Torsion of the spleen is a rare cause of abdominal pain. Predisposition occurs following abnormal development of splenic suspensory ligaments. We report a case of splenic torsion in a spleen sited in a normal anatomical position and discuss the latest treatment options. To the best of our knowledge, this has not been reported in the literature to date. Case Presentation A 73-year-old Caucasian woman presented to our department with sudden onset, severe, left-upper abdominal pain. An enhanced computed tomography revealed an unenhancing spleen. She underwent an urgent laparotomy and splenectomy for 360° torsion of her spleen. Conclusions Splenic torsion in a wandering spleen has been described with an incidence of < 0.2%. Symptoms vary from asymptomatic to an acute surgical abdomen. Diagnosis is commonly made using colour Doppler sonography or enhanced computed tomography. Surgery is guided by clinical setting, with preservation of the spleen as the goal.

Splenic torsion: a rare cause of abdominal pain

“…The described incidence rate is less than 0.2% 1. Predisposition occurs from abnormal development of splenic suspensory ligaments, sometimes called a ‘wandering’ spleen.…”

Partial splenic torsion in situ: Revealed by ultrasound and computed tomography

“…To the best of our knowledge, only one case with torsion of a spleen located in a normal anatomical position has been reported in the literature to date. [ 1 ] The patient in the referred case underwent an urgent laparotomy and splenectomy for 360° torsion of her spleen. Hence, the present case is unique because the 180° torsion occurred in normal anatomical position of spleen.…”

“…Whereas, in the present case, the spleen was in its normal anatomical position which is exceedingly rare and is mentioned in only one case report. [ 1 ] Lack of symptoms except abdominal pain may lead to difficulty in diagnosis of torsion. This issue may be more applicable to patients with partial splenic torsion in normal anatomical position, like in the present case.…”

Wandering spleen with a ten-time twisted vascular pedicle

“…1 Laxity or absence of the supporting ligaments predispose to spleen's migration in the abdominal cavity and torsion of its vascular pedicle. 2 Patients with WS can be asymptomatic or experience mild abdominal discomfort; in some cases splenic infarction occurs, representing thus a surgical emergency. 3 Hence, an accurate diagnosis is not deferrable.…”