The Cause of an Unusual Abdominal Pain in Children: Splenic Torsiyon – Three Case Report

Splenic torsion is a rare cause of abdominal pain that may develop due to laxity or absence of the ligaments that stabilize the spleen. A torsioned spleen may present with an acute abdomen clinically and may require urgent surgical intervention. We aimed to discuss three pediatric cases who applied to our clinic with acute abdomen symptoms after splenic torsion and their treatment approaches. Case 1: A 10-year-old female patient presented with complaints of progressive abdominal pain and non-bilious vomiting. On examination, there was abdominal tenderness and palpable fullness in the left lower quadrant. Imaging methods were compatible with splenic torsion. Laparoscopic splenectomy was performed. Case 2: A 4-year-old girl presented with complaints of abdominal pain and non-bilious vomiting. On examination, diffuse tenderness in the abdomen and defense-rebound were positive. Imaging methods were compatible with splenic torsion. On exploration, it was observed that the spleen was torsioned in different directions around the double pedicle. Splenectomy was performed. Case 3: A 5-year-old male patient was operated in another hospital with the complaint of abdominal pain, with the diagnosis of acute appendicitis, with open surgery. However, there was no improvement in the patient’s symptoms after surgery. The patient was consulted to our clinic on the 5th post-operative day. Imaging methods were found to be compatible with splenic torsion. Laparoscopic splenectomy was performed. In the pediatric population, splenic torsion can cause acute or chronic abdominal pain of unknown cause. Splenopexy should be the first goal of treatment in torsion, but splenectomy is the only treatment option in complicated cases and laparoscopy can be used safely even in complicated cases.

Çocuklarda karýn aðrýsýnýn olaðan dýþý bir sebebi: Dalak torsiyonu. 3 Olgu sunumu

Dalak torsiyonu, dalaðý stabilize eden baðlarýn gevþekliði veya yokluðuna baðlý olarak geliþebilen, akut veya karýn aðrýsýnýn nadir bir nedenidir. Torsiyone olmuþ bir dalak acil cerrahi giriþim gerektirebilmektedir. Dalak torsiyonu sonrasý akut karýn bulgularý ile kliniðimize baþvuran üç pediatrik olguyu ve tedavi yaklaþýmlarýný tartýþmayý amaçladýk.
Olgu 1: On yaþýnda kýz hasta, karýn aðrýsý, safrasýz kusma, þikâyeti ile baþvurdu. Batýn hassasiyeti, sol alt kadranda ele gelen dolgunluk mevcuttu. Görüntüleme yöntemleri dalak torsiyonu ile uyumluydu. Hastaya laparoskopik splenektomi yapýldý.
Olgu 2: Dört yaþýnda kýz hasta, karýn aðrýsý ve safrasýz kusma þikâyeti ile baþvurdu. Batýnda yaygýn hassasiyet, defans-rebound mevcuttu. Görüntüleme yöntemleri dalak torsiyonu ile uyumluydu. Laparotomi ile splenektomi yapýldý.
Olgu 3: 5 yaþýnda erkek hasta karýn aðrýsý þikayeti ile baþvurduðu baþka bir hastanede apandisit tanýsýyla açýk operasyon ile opere edilmiþ. Ameliyat sonrasý hastanýn semptomlarýnda herhangi bir iyileþme olmayýnca postoperatif beþinci günde kliniðimize konsülte edildi. Görüntüleme yöntemleri dalak torsiyonu ile uyumlu bulundu. Hastada laparoskopik splenektomi yapýldý.
Pediyatrik popülasyonda dalak torsiyonu nedeni bilinmeyen akut veya kronik karýn aðrýsýna neden olabilir. Torsiyonda dalak koruyucu yaklaþým tedavinin ilk amacý olmalýdýr ancak komplike vakalarda splenektomi tek tedavi seçeneðidir ve komplike vakalarda bile laparoskopi güvenle kullanýlabilir. (SETB-2021-05-156)