Detorsion of Wandering Spleen Causes Significant Hypersplenism Resulting in Thrombocytopenia and Spinal Cord Injury: A Case Report.

INTRODUCTION

We report the case of a child who underwent splenectomy and developed marked thrombocytopenia after detorsion due to wandering splenic torsion.

CASE PRESENTATION: A 7-year-old boy who underwent laparoscopic inguinal hernia surgery developed sudden abdominal pain 2 days later. Contrast-enhanced CT revealed a poor contrast effect in the spleen, and emergency surgery was performed based on the diagnosis of splenic infarction. The spleen was not fixed to the retroperitoneum and was twisted at 720° around the splenic hilum. However, the color tone improved after detorsion of the spleen; therefore, the spleen was preserved. The next day, the patient developed spinal cord injury due to marked thrombocytopenia and epidural hematoma, and emergency hematoma removal surgery was performed. As the patient continued to depend on platelet transfusion, laparoscopic splenectomy was performed. The patient's platelet counts rapidly increased after surgery. Since then, the patient has undergone treatment and rehabilitation for the spinal cord injury, and his neurological symptoms have improved.

CONCLUSIONS

Preserving the spleen is recommended for wandering splenic torsion, especially in children. In the present case, splenectomy was necessary because of rapid thrombocytopenia caused by increased splenic function after detorsion of the spleen; however, there have been no similar case reports in the past. This condition can be potentially dangerous and can lead to serious complications.