An unusual case of hemoperitoneum owing to acute splenic torsion in a child with immunoglobulin deficiency.
Wandering spleen is an uncommon clinical entity, which rarely affects children and adolescents. It is usually described in adults, being most common in the multiparous women of childbearing age. A case of a 14-year-old girl with a past history of splenomegaly and immunoglobulin A (IgA) deficiency, who presented with a sudden onset of abdominal pain, is presented. Diagnosis of hemoperitoneum secondary to torsion of a wandering spleen was made by computed tomography scan and Doppler ultrasound. Laparoscopy revealed hemoperitoneum owing to a ruptured and infarcted spleen. Laparotomy was undertaken and open splenectomy was successfully performed. The patient was discharged after an uneventful postoperative course that was not punctuated by any major complication. Management of this rare surgical emergency is discussed. Based on the details of this case, the authors hypothesize that IgA deficiency causes splenomegaly, which in turn predisposes to ligamentous laxity and splenic torsion.
Department of Gastrointestinal Surgery, Hospital Universitario de Canarias, Canary Islands, Spain. drtomassetti@wanadoo.es
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López-Tomassetti Fernández
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Arteaga González
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Martín Malagón
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Carrillo Pallarés
D000293:Adolescent; D003937:Diagnosis, Differential; D005260:Female; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D017098:IgA Deficiency / Q000150:complications*; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D050805:Wandering Spleen / Q000150:complications* / Q000601:surgery