Torsion of wandering spleen: The whorled appearance of the splenic pedicle on CT

Swischuk, Leonard E.; Williams, Jennifer; John, Susan D.

doi:10.1007/bf02012458

Cited by 60 publications

(46 citation statements)

References 8 publications

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“…In case of torsion the spleen rotate around its long pedicle. 10 The degree of torsion is founded from ½ to 6 complete around its axis. The factors that effect the severity of torsion are the weight of spleen, length of pedicle and degree of ligamentous laxity.…”

Section: Discussionmentioning

confidence: 99%

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Splenic Torsion in a Twin Premature 4 Month-Old Child Diagnosed by Color Doppler Sonography

2016

IJSR

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Introduction: Splenic torsion is a vary rare cause of acute abdominal pain in infancy. It is a major, serious and maybe fatal complication of wandering spleen in children. The spleen can "wander" or migrate into various positions within the abdomen or pelvis. The clinical presentation of a wandering spleen is variable. Diagnosis in the emergent setting can be challenging as it is a rare cause of acute abdomen and does not produce any symptoms until splenic torsion has occurred. The perfusion of the spleen is much affected by torsion. Sonoghraphy is an accessible diagnostic method and should be the first choice for identifying wandering spleen especially in children, although CT scan may be needed in certain cases to confirm diagnoses. In wandering spleen, during the sonographic examination, the spleen itself is located in a ectopic position in the abdomen for most cases even though it can also be found in its rightful place, the left upper quadrant. The torsion is the major complication. In case of torsion the spleen can be seen enlarged with parenchimal heterogenicity. Other findings in color Doppler like absence or decreased flow within the spleen , a whorled or tortuous twisted pedicle are important for the right diagnosis of torsion. Splenectomy is the treatment of choice after splenic torsion with infarction. Splenopexy can be performed in patients without splenic infarction. Case report: This is a retrospective case report of a 4 month-old premature-twin child with abdominal pain, distension, diarrhea and a body temperature of 37.5 0 Celsius. The sonographic examination revealed an enlarged spleen with a patchy heterogeneous echotexture in the upper left quadrant. Color doppler sonography showed total absence of flow in the splenic vein and artery. The patient underwent surgery. After derotation, viability of spleen appeared compromised. Emergency splenectomy was done. There was no postoperative complication and the patient was followed up in satisfactory condition. Histopathologic evaluation of the spleen revealed nearly complete infarction and congestion of the parenchyma. Conclusion: To conclude, torsion of the spleen is a very rare cause of an acute abdomen in pediatric patients. Diagnosis is challenge because of nonspecific clinical findings. Sonographic examination with color Doppler is the first imaging examination in children. In cases of extremely emergencyit it can help establish the diagnosis. Wondering spleen with torsion, while rare should nevertheless be taken into account when reviewing cases of children with acute abdomen.

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Section: Discussionmentioning

confidence: 99%

“…The spleen mostly migrates in the left lower quadrant, but other positions can be expected. It is usually intraperitoneal 10 . The causes for the defective suspended ligaments, responsible for wandering spleen are still not very clear.…”

Section: Discussionmentioning

confidence: 99%

Splenic Torsion in a Twin Premature 4 Month-Old Child Diagnosed by Color Doppler Sonography

2016

IJSR

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“…[6][7][8][9] The diagnosis may be suspected on ultrasound scans by noting absence of spleen from its usual expected location in the left upper quadrant. The ectopic spleen may show a normal ultrasound appearance, or may be enlarged and heteroechoic in appearance.…”

Section: 2mentioning

confidence: 99%

Torsion of a Wandering Spleen Presenting as a Painful Pelvic Mass Post Pregnancy: Imaging Diagnosis

et al. 2013

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A 'wandering' spleen is an uncommon condition most often found in young women, and may be incidentally detected or present acutely with splenic torsion. We report the case of a young woman who noticed an abnormal suprapubic lump after her first pregnancy, and subsequently presented seven months later with acute pain and sudden increase in size of the mass due to torsion of a pelvic spleen. We highlight the typical ultrasound and CT (computed tomography) imaging findings which helped to make a confident pre-operative diagnosis. Splenectomy was performed and confirmed the development of splenic infarction.

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“…2). Imaging findings were confirmed at laparoscopy, and splenic detorsion and splenopexy were performed.Excessive splenic mobility and resultant ectopia are caused by abnormal peritoneal fixation, with the splenogastric and splenorenal ligaments being either absent or lax [1,2]. While splenic shadow absence may suggest the diagnosis at radiography [1], US or CT is typically required to confirm the diagnosis.…”

mentioning

confidence: 99%

“…While splenic shadow absence may suggest the diagnosis at radiography [1], US or CT is typically required to confirm the diagnosis. Splenic ectopia may be complicated by vascular pedicle twisting, or torsion, with associated pain caused by splenic vascular congestion or infarction [1]. Abnormal fixation of the stomach to the spleen may allow gastric volvulus [2].…”

mentioning

confidence: 99%

The “wandering” spleen

Dillman

Strouse

2009

Pediatr Radiol

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A 15-year-old girl presented with 7 days of intermittent lower abdominal pain. Contrast-enhanced CT demonstrated an enlarged "wandering" spleen (asterisk) within the pelvis (Fig. 1). The splenic vascular pedicle was elongated and whorled, suggesting torsion (Fig. 2). Imaging findings were confirmed at laparoscopy, and splenic detorsion and splenopexy were performed.Excessive splenic mobility and resultant ectopia are caused by abnormal peritoneal fixation, with the splenogastric and splenorenal ligaments being either absent or lax [1,2]. While splenic shadow absence may suggest the diagnosis at radiography [1], US or CT is typically required to confirm the diagnosis. Splenic ectopia may be complicated by vascular pedicle twisting, or torsion, with associated pain caused by splenic vascular congestion or infarction [1]. Abnormal fixation of the stomach to the spleen may allow gastric volvulus [2]. Upon detection, most affected individuals are managed surgically with either splenopexy or splenectomy.

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Torsion of wandering spleen: The whorled appearance of the splenic pedicle on CT

Cited by 60 publications

References 8 publications

Splenic Torsion in a Twin Premature 4 Month-Old Child Diagnosed by Color Doppler Sonography

Splenic Torsion in a Twin Premature 4 Month-Old Child Diagnosed by Color Doppler Sonography

Torsion of a Wandering Spleen Presenting as a Painful Pelvic Mass Post Pregnancy: Imaging Diagnosis

The “wandering” spleen

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