Young Patient with Abdominal Pain.

A 15-year-old girl presented to the emergency department with a 2-year history of recurrent abdominal pain. Physical examination revealed a large, soft mass with an impalpable lower pole located in the right lower abdomen that was accompanied by tenderness without rebound tenderness. No other obvious abnormalities were found. Computed tomography angiography (CTA) showed heterotopic splenomegaly with splenic vascular torsion and dilatation (Figure 1). Color Doppler flow imaging showed no obvious infarcted areas (Figure 2). Considering that aggravation of abdominal pain may have been associated with torsion of the spleen, surgery was performed. The patient was discharged postoperatively after 10 days with no complications. The pain did not reoccur during 1-year follow-up.Figure 2Color Doppler flow imaging displaying the blood flow in the ectopic spleen (white arrows), with no obvious infarcted area.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Abdominopelvic ectopic spleen. Ectopic spleen often occurs in the hilum of the spleen and its adjacent tissues. However, a few cases can occur in the liver, adrenal glands, ovaries, scrotum, and pelvic cavity.1Rajaram B. Venkanna M. Kumar D.R. et al.Ectopic spleen presenting as lump abdomen: A rare case report and review of literature.J Clin Diagn Res. 2015; 9: PD26-PD27PubMed Google Scholar,2Mohammadi S. Hedjazi A. Sajjadian M. et al.Accessory spleen in the splenic hilum: A cadaveric study with clinical significance.Med Arch. 2016; 70: 389-391Crossref PubMed Scopus (5) Google Scholar In this case, we found that the ligaments around the spleen were absent, which was considered the main cause of the heterotopic spleen, an anomaly that is very rare in 15-year-olds. The intermittent abdominal pain was caused by the intermittent ischemia from distortion of splenic vessels, which was a result of the twisting of the enlarged spleen. Splenopexy can be selected for asymptomatic or young patients but for patients with a long spleen pedicle or with complications such as torsion, splenectomy is chosen to avoid recurrence.3Somasundaram S.K. Massey L. Gooch D. et al.Laparoscopic splenectomy is emerging ‘gold standard’ treatment even for massive spleens.Ann R Coll Surg Engl. 2015; 97: 345-348Crossref PubMed Scopus (18) Google Scholar,4Kapan M. Gümüş M. Onder A. et al.A wandering spleen presenting as an acute abdomen: case report.J Emerg Med. 2012; 43: e303-e305Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar