Acute torsion of a wandering spleen: a paediatric emergency

A 5-year-old boy presented to the emergency department with intense dull aching pain in the left lower abdomen. On physical examination, his vitals were stable. A well-defined, tender, firm, 10×6 cm sized mass was palpable in the left lower abdomen occupying the left hypochondrium, left lumbar and umbilical regions. Urgent ultrasound revealed the absence of spleen in the normal position with a hypoechoic encapsulated mass in the left lower abdomen while Doppler study showed the absence of internal vascularity in it. Contrast-enhanced CT (CECT) of the abdomen (figure 1A,B) confirmed the presence of an enlarged, minimally enhancing and inferiorly displaced spleen with characteristic ‘whirled appearance’ of the splenic hilum. The diagnosis of splenic …