Abstract
An 18 year old male with a history of prune belly syndrome (PBS) presented with acute
abdominal pain and palpable left upper quadrant mass. Computed tomography (CT) of
the abdomen revealed a medialized spleen with a “whirl sign” in the splenic vessels,
consistent with splenic torsion. Coincidentally, the small bowel was also noted to
be on the right side of the abdomen, while the colon was located on the left, indicative
of malrotation. Emergent diagnostic laparoscopy confirmed splenic torsion and intestinal
malrotation. Successful laparoscopic reduction of the splenic torsion was achieved,
however, conversion to an open procedure by a vertical midline incision was necessary
owing to the patient's unique anatomy. Open splenopexy with a mesh sling and Ladd's
procedure were subsequently performed. Malrotation and wandering spleen are known,
rare associated anomalies in PBS; however, both have not been reported concurrently
in a patient with PBS in the literature. In patients with PBS, acute abdominal pain,
and an abdominal mass, high clinical suspicion for gastrointestinal malformations
and prompt attention can result in spleen preservation and appropriate malrotation
management.
We present a case of a teenager who presented with a history of PBS, acute abdominal
pain, and a palpable abdominal mass. The patient was found to have splenic torsion
and intestinal malrotation. The clinical findings, diagnostic imaging, and surgical
treatment options of splenic torsion are reviewed.
Key words
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References
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Article info
Publication history
Accepted:
November 27,
2012
Received in revised form:
November 26,
2012
Received:
November 4,
2012
Footnotes
☆Disclosure: The material contained herein has not been previously published or submitted elsewhere for publication and will not be sent to another journal until a decision is made concerning publication by the Journal of Pediatric Surgery. In addition, the authors cite no personal conflicts of interest or financial arrangements with the organizations, corporations, and/or devices detailed in this manuscript. No sources of external funding were utilized.
☆☆Copyright: The undersigned author(s) transfer all copyright ownership of the manuscript to the Journal of Pediatric Surgery in the event the work is published. The authors warrant that the article is original, does not infringe upon any copyright or other proprietary right of any third party, is not under consideration by another journal, and has not been published previously.
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Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
