General Surgery Department of Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, 56# Nanlishi Road, Beijing, 100045, China.
BMC Pediatr. 2022 Jul 22;22(1):440. doi: 10.1186/s12887-022-03484-y.
Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction.
From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized.
There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4-170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient.
Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen.
小儿脾扭转是一种罕见的疾病，最常见的原因是游走脾。本研究旨在总结我们在小儿脾扭转的诊断和手术治疗方面的临床经验，并将术前血小板增多症作为脾梗死的术前预测因素。
从 2016 年 1 月 1 日至 2021 年 12 月 31 日，共纳入 6 例诊断为脾扭转的患儿。所有患者均接受手术治疗并随访。收集了包括临床表现、实验室检查、影像学结果、手术过程和预后等临床资料。总结了诊断和手术治疗的临床经验。
患儿中女性 4 例，男性 2 例，中位手术年龄为 102.6（9.4-170.7）个月。腹痛和腹部包块是最常见的表现。脾扭转的诊断依赖于影像学检查，1 例患儿在对比 CT 上观察到相邻器官受累（胃和胰腺扭转）。5 例患儿诊断为游走脾扭转，1 例诊断为游走副脾扭转。所有患儿均行急诊腹腔镜或开放脾切除术。病理检查发现 4 例患儿全脾梗死，1 例部分梗死，1 例脾淤血伴出血。4 例脾梗死患儿术前血小板计数升高，2 例存活脾患儿血小板计数正常。术后 1 例患儿门静脉分支短暂血栓形成。
影像学检查对小儿脾扭转及相邻器官受累的诊断至关重要。术前血小板增多症可能预测脾梗死。对于有存活脾的患儿，应认真考虑保留脾脏手术，而非脾切除术。
