Postraumatic Torsion of Wandering Spleen in 9-year-old Boy

Abstract

Post-traumatic torsion of wondering spleen is extremely rare cause of acute abdominal pain in children with only few cases reported. We report a case of a 9-year-old boy with wandering spleen torsion after bike crash and subacute clinical presentation. After a bicycle crash and a period of persistent fever family physician performed an ultrasound of abdomen which showed a round focal lesion of 10 x 12 cm in size, a spleen-like echogenicity in the middle-lower abdominal position and in the small pelvis, which raised suspicion of ectopic (wandering) spleen. The abdominal MSCT confirmed the diagnosis of wandering spleen, Numerous immunologic, hematological, radiological, infectious, endocrinological, chromosomal and cytological tests and markers confirmed a diagnosis of the splenic malformation. A surgeon arranged to perform splenopexy after checking the vaccination status. Laparotomy was initiated. The splenic artery and vein, which was in a triple twist, was released and due to the resulting path, the spleen itself was larger than the CT finding. The spleen was placed under the left ribs and splenopexy was performed. At the fifteen-day and two-month follow ups, the patient felt good, was painless, afebrile and the spleen gradually decreased. Wondering spleen should be considered as a possible cause of acute abdominal pain when the spleen is not seen in its usual position. The treatment of choice is surgery, with the goal of preservation of the organ whenever possible.