# Splenic Torsion in a Patient With Situs Inversus Totalis and Polysplenia: Challenging Diagnosis and Treatment of a Rare Case

## TL;DR

A rare case of splenic torsion in a patient with situs inversus totalis and polysplenia was successfully treated with laparoscopic splenectomy.

## Contribution

This case highlights the challenges in diagnosing and treating splenic torsion in patients with rare anatomical abnormalities.

## Key findings

- CT imaging confirmed splenic torsion and infarction in a patient with situs inversus totalis and polysplenia.
- Hand-assisted laparoscopic splenectomy was safely performed and resulted in an uneventful recovery.
- Patients with situs inversus or polysplenia are at higher risk for splenic torsion due to abnormal anatomy.

## Abstract

Splenic torsion is a rare condition caused by the twisting of the splenic pedicle, potentially leading to parenchymal infarction. We report a case of splenic torsion in a young patient with situs inversus totalis, isolated polysplenia, and a wandering spleen, without other cardiothoracic or digestive anomalies. An 18-year-old female, already known for situs inversus totalis, presented in the emergency department of a regional hospital with sudden right abdominal pain associated with vomiting. Laboratory tests showed leukocytosis and elevated C-reactive protein. Abdominal CT confirmed the situs inversus totalis and revealed a polysplenia with a well-delimited hypodense mass suspected of infarction of the main spleen due to the torsion of its vascular pedicle. After the emergency patient’s transfer to our tertiary hospital (Lausanne University Hospital, Lausanne, CHE), hand-assisted laparoscopic splenectomy was performed. The postoperative course was uneventful, and the patient was discharged on the third postoperative day.

Splenic torsion is a rare but serious condition requiring prompt diagnosis and surgical intervention. Patients with situs inversus, polysplenia, or a wandering spleen are predisposed to splenic torsion due to abnormal anatomy. Imaging by CT is crucial for diagnosis, and laparoscopic splenectomy remains a safe and effective treatment when infarction occurs.