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Wandering spleen with splenic torsion in a toddler: A case report and literature review.

Abstract：

RATIONALE:Wandering spleen (WS) is a rare clinical entity characterized by splenic hypermobility caused by absent or abnormal laxity of the suspensory ligaments, which fix the spleen in its normal position. Due to abnormal attachment, the spleen is predisposed to torsion and a series of complications. Pediatric WS is mostly reported in children aged <10 years, especially among infants aged <1 year; it is uncommon among toddlers between 1 and 3 years. To the authors' knowledge, only seven cases of WS have been described previously. Herein, we present the case of a 3-year-old toddler with WS and splenic torsion. PATIENT CONCERNS:A 3-year-old boy was presented to the pediatric emergency room with a 2-day history of abdominal pain and vomiting. The ultrasonographic examination revealed a mass in the left upper abdomen cavity and absence of spleen in its normal position. Computed tomography showed an enlarged displaced spleen occupying the left abdomen cavity with an elongated splenic vascular pedicle (whirl sign), suggesting splenic torsion. DIAGNOSES:The patient was diagnosed that had WS and splenomegaly, with or without complications due to splenic torsion. INTERVENTIONS:The patient underwent emergency laparotomy and splenectomy due to nonviability after detorsion. OUTCOMES:The postoperative course was uneventful, and the patient was discharged on the 7th day postoperatively without complications. The patient had favorable outcome over a 1-year follow-up. LESSONS:Herein, we reported the case of a toddler with WS with splenic torsion. Moreover, after reviewing relevant studies in literature, we presented our findings on the diagnosis and treatment of toddlers with WS. Toddlers with WS are characterized by acute abdominal pain, unclear history description, examination restrictions, and high rates of life-threatening complications. High level of suspicion, careful physical examination, detailed history collection, and objective investigation are crucial in the management of toddlers with WS.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Wang Z,Zhao Q,Huang Y,Mo Z,Tian Z,Yang F,Wang Y,Yao L

doi

10.1097/MD.0000000000022063

subject

Has Abstract

pub_date

2020-09-11 00:00:00

pages

e22063

issue

eissn

0025-7974

issn

1536-5964

pii

00005792-202009110-00032

journal_volume

pub_type

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Wandering spleen with splenic torsion in a toddler: A case report and literature review.