[Uncommon etiology of acute abdomen in pediatric age: the torsion of spleen].
The torsion of spleen on its vascular shank represents an uncommon problem, responsible of acute and chronic pain. The mobile spleen is fixed only through hilus vessels the gastrosplenic ligament. The incidence is unknow, greater in the male with an M:F ratio 6.1 in the first ten years of life, even if an episode of intrauterine torsion has been reported. The diagnosis can be performed with ultrasonography, angiography, scintigraphy and CT scan. There are reported two cases: male of 2.5 years female of 14 years who presented with recurrent pain to the left side, vomit diarrhoea and fever. Objectively a palpable mass was present. Ultrasonography and angio-CT scan of abdomen revealed splenomegaly, ptosis of the spleen and malrotation with signs of obstruction of the vessels. The treatment in both cases was splenectomy. The spleen appeared rotated on its shank and increased of volume, deprived of anatomical structures of fixation. The histological report confirmed the haemorrhagic infarction. The excessive mobility of the spleen, from insufficiency or absence of the ligamentous attachments is case of abdominal pain or acute abdomen, that can complicate with the infarction of the spleen. Angio-CT scan, in the cases here reported, has shown to greater sensibility in comparison to the ultrasonography. The Authors believe that the video-laparoscopic splenopexy, when the diagnosis is made of "wandering spleen" with painful repeated episodes, can be finalized, to the preservation of organ.
Marinaccio
F
F
U.O. Chirurgia Pediatrica, Azienda Ospedaliero-Universitaria OO.RR., Foggia.
Caldarulo
E
E
Nobili
M
M
Magistro
D
D
Marinaccio
M
M
D000006:Abdomen, Acute / Q000209:etiology*; D000293:Adolescent; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D011860:Radiography, Abdominal; D013156:Splenectomy; D013158:Splenic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013163:Splenomegaly / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality; D016896:Treatment Outcome; D014463:Ultrasonography