Splenic Torsion Following Blunt Abdominal Trauma

TL;DR

This paper examines rare cases of splenic torsion following blunt abdominal trauma, focusing on symptoms, diagnosis, and outcomes in young patients.

Contribution

The study provides a detailed analysis of eight traumatic splenic torsion cases, highlighting diagnostic challenges and management strategies.

Findings

Splenic torsion after trauma is rare and often diagnosed via imaging in young patients.

Laparotomy with splenectomy was the most common treatment, with one case preserving the spleen.

Histopathology confirmed infarction in only one case due to incomplete data in others.

Abstract

Background/Objectives: Splenic torsion is a well-known and reported clinical problem. Splenic torsions after abdominal trauma represent a small group of cases that involve surgical management. They manifest primarily as abdominal pain, and the diagnosis is made based on imaging studies—ultrasound, CT, and MRI. Methods: This work aimed to analyze traumatic splenic torsions in terms of their clinical course, symptoms, timing, involvement of imaging techniques in the diagnosis, histopathological examination, and overall outcome. We searched databases using the desk research method under the keywords “splenic torsion”, “torsion”, and “spleen”, as well as in combination with “traumatic”, finding a total of eight cases, which we included in our analysis. Results: The eight cases were analyzed, comprising four females and four males, with an average age of 16.25 years (range 5–29 years). Traffic accidents were the most frequent cause of injury (five cases), while the circumstances were unclear in the remaining three. Immediate abdominal symptoms appeared in six patients. Splenic torsion was preoperatively diagnosed in five out of seven confirmed cases. A total of seven patients underwent laparotomy with splenectomy. In one case, laparoscopy converted to laparotomy with splenopexy preserved the spleen. Histopathology, performed in only two cases, confirmed splenic infarction in one patient; infarction status could not be determined in the remaining five due to missing data. Conclusions: Post-traumatic splenic torsions are a group of atypical injuries as the primary and immediate consequence of the trauma suffered is not anatomical–structural damage to the organ, such as a rupture. Mostly affecting young people, the cases described in the professional literature involve the main spleen, which was considered to be “wandering”, suggesting that this is a key predisposing factor for splenic torsion following blunt trauma and requiring diagnostic imaging for diagnosis.