title: Non-operative management of a rare diagnosis of splenic torsion in a child with a history of giant omphalocele: a case report and literature review.
abstract: BACKGROUND
  Splenic torsion is rare and as a result the appropriate management is unclear. While there has been a shift towards splenectomy and laparoscopic splenopexy, we present a successful case of non-operative management of splenic torsion in a patient with a history of a giant omphalocele.
  
  
  METHODS
  A 3 year-old female presented with a three-day history of abdominal pain, fever and non-bloody emesis three and a half years after repair of her giant omphalocele. Abdominal radiographs and ultrasound demonstrated migration of the spleen and a subsequent computerized tomography scan confirmed splenic torsion and an infarcted spleen. Given her late presentation, she was successfully managed with observation, analgesia, immunization against capsulated organisms and daily penicillin prophylaxis with excellent outcome at 19 months follow-up. A review of the literature revealed that splenic torsion is rarely managed non-operatively. Rarer still is the occurrence of splenic torsion following a history of omphalocele.
  
  
  CONCLUSIONS
  Although rare, splenic torsion should be considered in a child with a history of omphalocele presenting with abdominal pain. Non-operative management of an infarcted spleen can be a safe treatment option to avoid surgery in complex patients.
authors.forename: Fariha
authors.initials: F
authors.lastname: Sheikh
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kim
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.affiliation: Division of Pediatric Surgery, Michael E DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston TX, USA. oolutoye@bcm.edu.
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye