Spleen Wandering and Axial Torsion following Nissen Fundoplication: A Case Report
Wandering spleen and its axial torsion is a very rare entity that presents with abdominal pain. Splenic torsion might be related to the division of the long vascular pedicle of spleen, or to its weight in portal hypertension. Splenic torsion and infarction following Nissen fundoplication is a rar...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cairo University, Faculty of Medicine, Department of Pediatrics
2025-07-01
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| Series: | Pediatric Sciences Journal |
| Subjects: | |
| Online Access: | https://cupsj.journals.ekb.eg/article_426852_3cae15184050cb26a43d9a95c296b89f.pdf |
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| Summary: | Wandering spleen and its axial torsion is a very rare entity that presents with abdominal
pain. Splenic torsion might be related to the division of the long vascular pedicle of spleen, or to
its weight in portal hypertension. Splenic torsion and infarction following Nissen fundoplication
is a rare long-term but potentially life-threatening complication. We report the case of a 17-year-
old female who presented to emergency room by severe agonizing incapacitating left
hypochondrial pain. She had been suffering from indolent abdominal pain for 4 months that
alternated with attacks of severe pain, the pain recurred more frequently and increased in
intensity during the past week prior to her presentation. There was no vomiting, fever or any
other symptoms, and she was vitally stable except for tachycardia. Her medical history was
remarkable, with 3 previous surgical interventions. She underwent an appendectomy, an
exploratory laparotomy for intestinal obstruction and laparoscopic Nissen fundoplication. A
thorough examination of the patient, and computed tomography (CT) scan of her abdomen
showed torsion of the spleen. Exploratory laparotomy, revealed a midline positioned spleen of
dusky discoloration. Repositioning did not achieve improvement in spleen color and splenectomy
were performed. The patient was discharged without any incidents or complications. Splenic
torsion is a rare complication of Nissen fundoplication surgery, that is life-threatening. A high
index of suspicion is necessary for diagnosis. While exploratory laparotomy is the golden
diagnostic standard, Doppler of splenic vein and CT abdomen are valuable. The indolent pain
alternating with episodic more severe nature of the pain might be related to the rate and
direction of splenic vessels axial torsion (twisting and untwisting), i.e. rate of partial compression
and relief of compression of the blood flow in the long vascular pedicle of spleen until it reaches
complete torsion and complete obstruction. Early diagnosis is essential to prevent splenic
infarction and morbidity. Exploratory laparotomy was lifesaving in our reported case. |
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| ISSN: | 2805-279X 2682-3985 |