Images in Paediatrics
Splenic torsion as a cause of acute abdomen
Torsión esplénica como causa de abdomen agudo
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"<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Rocío" "apellidos" => "Ruiz Marzo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitario de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Cirugía General y Digestiva, Hospital Universitario de Navarra, Pamplona, Navarra, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Torsión esplénica como causa de abdomen agudo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 541 "Ancho" => 1207 "Tamanyo" => 67955 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0430" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal ultrasound of the left hypochondrium. <span class="elsevierStyleBold">A</span> image shows an enlarged spleen (13<span class="elsevierStyleHsp" style=""></span>mm) for the patient's age, with heterogeneous echogenicity (red star). In addition, there were seen geographical areas with well-defined hypoechogenic borders inside the spleen (red arrow), due to ischaemia. <span class="elsevierStyleBold">B</span> image demonstrates moderate amount of intra-abdominal free fluid (red asterisks).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A child aged 4 years presented to the emergency department with abdominal pain of 4 days’ duration without prior trauma. The physical examination revealed the presence of a palpable mass and abdominal guarding in left hypochondrium. Laboratory tests revealed leucocytosis (15.3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/L), a low haemoglobin concentration (9.5<span class="elsevierStyleHsp" style=""></span>g/dL) and haematocrit (29%), a prolonged prothrombin time (14.7<span class="elsevierStyleHsp" style=""></span>s) and elevation of fibrinogen (888<span class="elsevierStyleHsp" style=""></span>g/L). An abdominal ultrasound scan was ordered, which revealed a moderate amount of intra-abdominal free fluid and an enlarged spleen (13<span class="elsevierStyleHsp" style=""></span>mm) with heterogeneous echogenicity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). An acute process involving the spleen was suspected, prompting performance of a contrast-enhanced abdominopelvic computed tomography (CT) scan that revealed torsion of the spleen along the hilar axis and global splenic infarction (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). An exploratory laparoscopy was carried out in the department of paediatric surgery, evincing the absence of splenic suspensory ligaments (SSLs) and with visualization of the previously detected hilar torsion and infarcted spleen, which required splenectomy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Wandering spleen (WS) is an uncommon entity caused by the laxity or absence of SSLs, resulting in a predisposition to splenic torsion with rare involvement of other organs.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It is usually found in children aged less than 10 years,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> and its clinical presentation ranges from the presence of an asymptomatic abdominal mass to acute abdomen due to splenic infarction.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Sonography is the main imaging test used for diagnosis of WS, but contrast-enhanced CT or magnetic resonance imaging contributes information on the viability of the spleen that is key to decide whether splenectomy is required.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 541 "Ancho" => 1207 "Tamanyo" => 67955 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0430" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal ultrasound of the left hypochondrium. <span class="elsevierStyleBold">A</span> image shows an enlarged spleen (13<span class="elsevierStyleHsp" style=""></span>mm) for the patient's age, with heterogeneous echogenicity (red star). In addition, there were seen geographical areas with well-defined hypoechogenic borders inside the spleen (red arrow), due to ischaemia. <span class="elsevierStyleBold">B</span> image demonstrates moderate amount of intra-abdominal free fluid (red asterisks).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1342 "Ancho" => 1874 "Tamanyo" => 270648 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0435" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Contrast-enhanced abdominopelvic-CT in arterial phase (A) and portal venous phase (B–D). <span class="elsevierStyleBold">A</span> image in the arterial phase exposes the splenic artery looping in its final portion at the level of the splenic hilum (red arrow). <span class="elsevierStyleBold">B</span> image with an anterior displacement of the tail of the pancreas due to torsional traction (red arrowhead). <span class="elsevierStyleBold">C, D</span> images shows a heterogeneous nodular area fatty content in the splenic hilum compatible with a twisted hilum (red arrow), and an enlarged homogeneously hypodense spleen in relation to massive infarction (red star).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wandering spleen with splenic torsion in a toddler: a case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Z. Wang" 1 => "Q. Zhao" 2 => "Y. Huang" 3 => "Z. Mo" 4 => "Z. Tian" 5 => "F. Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MD.0000000000022063" "Revista" => array:6 [ "tituloSerie" => "Medicine (Baltimore)." "fecha" => "2020" "volumen" => "99" "paginaInicial" => "e22063" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32925740" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0169500217304415" "estado" => "S300" "issn" => "01695002" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Splenic torsion: a rare cause of abdominal pain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Mohseni" 1 => "B.T. Kruse" 2 => "C. Graham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bcr-2018-224952" "Revista" => array:4 [ "tituloSerie" => "BMJ Case Rep." "fecha" => "2018" "volumen" => "2018" "itemHostRev" => array:3 [ "pii" => "S014067361632517X" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Splenic torsion with involvement of pancreas and descending colon in a 9-year-old boy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Seif Amir Hosseini" 1 => "U. Streit" 2 => "J. Uhlig" 3 => "L. Biggemann" 4 => "F. Kahl" 5 => "S. Ahmed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjrcr.20180051" "Revista" => array:3 [ "tituloSerie" => "BJR Case Rep." "fecha" => "2018" "volumen" => "5" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000010000000001/v1_202401141514/S2341287923002582/v1_202401141514/en/main.assets" "Apartado" => array:4 [ "identificador" => "77701" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Paediatrics" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000010000000001/v1_202401141514/S2341287923002582/v1_202401141514/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923002582?idApp=UINPBA00005H" ]
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