715 The Acute Abdomen: Have You Ruled Out Splenic Torsion?
V Nebo, O Adeshina, J Cooke- Surgery
Abstract
Background
Splenic torsion is very rare, with approximately 500 cases reported worldwide and an incidence of 0.2% (1). The aetiology is thought to be hypermobility of the spleen’s supporting ligaments enabling migration to the pelvic or iliac region of the abdomen. The presentation can range from asymptomatic to a surgical emergency.
It is thought that the under-diagnosis of this condition leads to the higher prevalence of surgical emergency type presentations.
Aim
We present a rare case of an acute abdomen, secondary to torsion, due to a massive splenic cyst. A literature review detailing the most common symptoms, signs and investigations in adult patients is reported, to aid the reader rule out this rare but life-threatening condition in clinical practice.
Method
We performed a PubMed search using the terms ““splenic torsion” or “twisted spleen” or “wandering spleen””. Only acute (<3months) (3) symptomatic presentations in adult human patients (>18years), who had confirmed splenic torsion were included. Of the 220 case reports/series found, 100 did not meet the inclusion criteria, were not accessible in English, or did not describe the patient symptoms.
Results
Of the 120 acute splenic torsion adult cases between 1974-2022 evaluated, the most common symptom was abdominal pain (95%) then vomiting (34.2%). The most frequent sign was abdominal mass (61.7%). Diagnosis was most commonly confirmed by CTAP (76.7%).
Conclusions
Splenic torsion is an important differential in the acute abdomen patient presenting with abdominal pain, vomiting and a palpable mass. This life-threatening condition can usually be excluded by CTAP.