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

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 37.50 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.