1 An extraordinary acute abdomen - Splenic torsion and repaired exomphalos major. A case report and review of the literature.
Georgina Bough, Roberta Iacona, Benjamin Ravenhill, Stephen Farrell
Addenbrookes, Cambridge, United Kingdom

Abstract

Aim: To raise awareness of splenic torsion as a cause of an acute abdomen in children with intra-abdominal congenital anomalies, review the published literature and discuss controversies in management.

Methods: Clinical notes review, with intraoperative and preoperative imaging. A structured literature review of PUBMED articles with the search term ‘splenic torsion’. Inclusion criteria: Original research articles published in the English language regarding splenic torsion (adults and children). Exclusion criteria: Torsion of an accessory spleen, animal studies, full text article not available. Titles were screened by 2 researchers and full texts reviewed by 4 researchers and summarised.

Main Results: Case report - A 7 year old male with a week’s history of intermittent, severe abdominal pain and non-bilious vomiting diagnosed on US and CT with torsion of a wandering spleen with concern of pancreatic involvement and vascular compromise of the stomach.  Laparotomy confirmed splenic torsion with a necrotic spleen and an uncomplicated splenectomy was performed.  After an uneventful recovery the patient was discharged on the 5th post-operative day with prophylactic antibiotics and post splenectomy vaccinations 2 weeks post operatively.  Literature review - 585 articles identified, 289 met criteria.  One other case identified with co-existing exomphalos and splenic torsion. Management in the majority of reported cases consists of laparotomy and splenectomy with occasional case reports in recent years proposing laparoscopic management, non-operative management and spleen preserving surgery.

Conclusion:  Splenic torsion is a rare but important clinical entity that benefits from prompt identification and should be considered in children with rotational anomalies.  Diagnosis and management can be challenging with non-specific presentation and definitive diagnosis requiring multiple imaging modalities.  Assessment and management require a multidisciplinary approach.  Despite the traditional approach of laparotomy and splenectomy a conservative or spleen preserving approach can be considered as an option, particularly in complex patients or those with a delayed presentation.


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