Presentation
3-day history of vomiting, fever, abdominal pain and mild abdominal distension.
Patient Data
Left upper quadrant mass with displaced bowel loops.
Enlarged, displaced spleen with significantly low density suggestive of infarction and early liquefaction. This can be mistaken for a collection. Torsion of the splenic pedicle, with occluded splenic artery and vein forming the 'whirl sign'. Associated thrombosis of the SMV and the portal vein, extending to the intrahepatic branches.
Case Discussion
Splenic torsion results from a volvulus of a wandering spleen 1-3. This is more common in females, particularly in conditions that cause splenomegaly or laxity of ligaments anchoring the spleen.
The condition is rare (0.2%) 2, and its diagnosis is often challenging with non-specific abdominal symptoms. However, as presented above, a high-risk patient with an enlarged hypodense spleen and a twisted pedicle forming a 'whirl sign' is diagnostic.
This patient had a laparotomy three weeks after presentation when the diagnosis was finally made. A torsed infarcted spleen was found, and a splenectomy was performed. The patient fully recovered.
Early diagnosis was not made on the first CT abdomen when the patient first presented three weeks earlier.
A wandering/ectopic or an early splenic volvulus with no features of infarction can be treated with splenopexy three as the risk of torsion is high in these cases 2,3.
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