Acute abdomen due to torsion of wandering spleen: CT diagnosis

Two adults and a child with acute abdomen and surgically confirmed torsion of wandering spleen are presented. Computed tomography provided a spectrum of findings including an ovoid or comma-shaped abdominal mass, hypertrophy of the liver's left lobe, a whirled appearance of hyperdense, nonenhancing splenic vessels, and an enlarged spleen, exhibiting minimal or no enhancement. Computed tomography also indicated the point of torsion and the viability of splenic parenchyma. Received 20 August 1997; Revised 10 February 1998; Accepted 11 February 1998     

Splenic volvulus on ectopic spleen in adults: A case report

Ectopic spleen is a rare clinical entity characterized by splenic hypermobility which may be congenital or acquired. The spleen may be migrated to different positions in the peritoneum. The main complication is pedicular torsion with splenic volvulus, presenting as an emergency abdominal surgery. We present and discuss a case of ectopic and twisted spleen resulting in complete splenic infarction, diagnosed by ultrasound, confirmed by CT scan and treated by splenectomy.     

Wandering spleen torsion in a patient with polysplenia syndrome

Polysplenia Syndrome is a rare condition that refers to the presence of 2 or more spleens in association with other thoracoabdominal abnormalities. Here, we report a case of a 13-year-old girl who presented with acute lower abdominal pain and was diagnosed with polysplenia syndrome after obtaining a CT scan of her chest, abdomen and pelvis. Diagnostic imaging also revealed the presence of a wandering spleen hanging in the lower abdomen and upper pelvic cavity and showing signs of infarction. The patient underwent splenectomy afterward and splenic torsion was confirmed intraoperatively. To the best of our knowledge, this was the first reported case of wandering spleen torsion in a patient with polysplenia syndrome. Physicians should keep in mind the possibility of a wandering spleen torsion presenting in various locations when dealing with polysplenia syndrome patients complaining of abdominal pain.     

Rare cause of postoperative acute abdominal pain: Giant omental infarct later complicated by colonic fistulization

Omental infarction is caused by vascular obstruction with resulting tissue ischemia, representing a rare cause of abdominal pain. It has been described as a rare complication of gastric bypass. It is important to recognize omental infarction and its possible complications as The management is usually conservative with surgery deferred to specific cases. We present the case of a 56-year-old male with a history of gastric adenocarcinoma who underwent esophagogastrectomy with Roux-n-y reconstruction and 3 months later presented with severe persistent abdominal pain, due to a path proven giant omental infarction. Patient later was complicated with a colonic fistula to the omentum.     

The unusual cause of recurrent abdominal pain in an 11-year-old boy

The case of an 11-year-old boy with recurrent abdominal pain is presented. Physiological findings were found normal during a clinical investigation, as well as many laboratory tests, ultrasonography and CT of abdomen. Only a high level of sedimentation rate and the focus of increased activity in the sacral region on scintigraphy using 99mTc-HMPAO (hexamethypropyleneaminooxime) labelled leukocytes were found. The other findings on bone scintigraphy, X-ray and MRI led to a deflection of the correct diagnosis. The real culprit proved to be an ingested foreign body (a piece of a wooden skewer) that the patient failed to reveal.     

Iatrogenic splenic injury in postoperative patients: a series of case reports

The purpose of this study was to report case studies of iatrogenic splenic injuries on computed tomography (CT) in symptomatic postsurgical patients. The medical records and CT studies of all patients with injury to the spleen after abdominal surgery were reviewed. CT was performed in the postoperative period, urgently in all patients. Unsuspected splenic injuries were found on CT performed in the early postoperative period in seven symptomatic patients (five women and two men, age range 21–81 years) after various abdominal surgical procedures. Injuries as detected on CT included splenic infarct in five, subcapsular hematoma in two, and laceration of the spleen in one. These findings were the only abnormal abdominal findings in four of the patients and were probably the source of the postoperative abdominal pain and fever. Splenic injury is a rare complication of abdominal surgery. It is often the radiologist who diagnoses the injury, and awareness of this possible complication can obviate further investigations.     

Pyocolpos: A rare cause of recurrent abdominal pain - Always insist on a thorough physical examination

Thorough physical examination is a must for proper diagnosis of medical diseases and to elucidate all physical findings. Abdominal pain is a very common presentation to Emergency Department, compromising 5%-10% of all visits, and around a quarter are discharged with no particular diagnosis. Pyocolpos is one of those presentations that requires a thorough physical examination, including that of the external genitalia. A 3-year-old girl presented with recurrent history of abdominal pain and a recent history of fever with acute abdomen picture-like presentation, with difficulty voiding over the past few days. She was previously assessed for recurrent abdominal pain, without any identifiable etiology. Upon inspection for indwelling catheter insertion, absence of the vaginal introitus was noted with a bulging mass and an imperforate hymen. Pyocolpos was diagnosed and drained following hymenotomy. Pyocolpos is a rare complication of hydrocolpos. Enlarged vagina causes extrinsic compression to nearby structures, such as the bladder trigone and ureters, causing hydronephrosis, hydroureter, and other sequel including acute kidney injury and urosepsis. An imperforate hymen must be considered in the differential for chronic and recurrent abdominal pain, and can be easily identified by a thorough physical examination, including that of the external genitalia, which is a must in today''s every medical practice.     

Spontaneous round ligament hematoma as an unusual cause of pelvic pain in a young female patient: MRI demonstration

The cause of pelvic pain remains a significant diagnostic challenge, even for experienced radiologists. An accurate differential diagnosis has to be done according to the patient''s age and gender. Spontaneous round ligament hematoma is an uncommon cause of acute pelvic pain in adult female patients. To the best of our knowledge, it has never been reported in the literature in the paediatric population. Ultrasound examination is the first line imaging modality for pelvic pain evaluation in young women but it might result inconclusive. Thanks to its panoramic view and multiparametric approach, the MRI can play a pivotal role in the diagnosis of spontaneous round ligament hematoma in paediatric female patients, resulting in a more effective patient''s therapeutic management.     

MRI-findings of nodular lesions in an enlarged spleen, associated with visceral Leishmaniasis

We present a case of a 15-month-old Moroccan girl with fever of unknown origin, hepatosplenomegaly and multiple hypoechoic nodular splenic lesions that appear hypodense on CT. T2-weighted MRI sequences show a markedly inhomogeneous intensity of the parenchyma, seemingly caused by multiple ill-defined and heterogeneous hypointense nodules. Laboratory tests confirmed a recent infection with Leishmania, a parasite endemic to (sub)tropic regions. During and after therapy these lesions gradually resolved. To our knowledge this is the second published case in which different imaging modalities were able to demonstrate organ lesions associated with Leishmania. It is also the first report of MRI-findings associated with these lesions.     

Pregnancy and abdominal pain: Value of ultrasound in diagnosis

Ultrasound is noninvasive, safe, and versatile. It seems an ideal imaging modality in the pregnant patient, in whom ionizing radiation must be kept to a minimum, yet accurate imaging is important in directing treatment. The objective of our study was to investigate the value of ultrasound as a first-line imaging modality in pregnant women with abdominal pain. We prospectively studied 41 consecutive pregnant patients with abdominal pain over a 1-year period. The setting was a busy private practice in a large teaching hospital with both a primary and tertiary care referral base. Diagnoses were categorized into urologic, biliary, bowel, and obstetric/gynecologic pathology. There were 23 positive diagnoses of the 41 patients in the series, encompassing 13 cases of urinary pathology (calculi, pyelonephritis, and overdistention syndrome), 2 cases of bowel pathology (appendicitis and Crohn's disease), 6 cases of biliary disease (gallstones and a case of choledocholithiasis), and 2 cases of obstetric/gynecologic pathology (threatened abortion and corpus luteum cyst). Ultrasound correctly diagnosed 18 of these 23 cases. The remaining 5 false-negatives were 3 cases of urinary calculi, 1 case of appendicitis, and 1 case of choledocholithiasis. There were 18 true-negative and no false-positives. The sensitivity of ultrasound in our series was 78%, specificity was 100%, and overall accuracy was 88%. Although there are limited numbers of specific diagnoses, we think that our patient population as a whole represents some of the more commonly evaluated complications in pregnancy. We conclude that sonography is a valuable first-line imaging modality in diagnosis of the pregnant patient with pain.     

CT findings in small bowel angioedema: a cause of acute abdominal pain

A patient who presented with acute abdominal pain secondary to small bowel angioedema is reported. Characteristic imaging features are highlighted with clarifying images. The importance of considering this diagnosis in patients presenting with acute abdominal pain correlated with the appropriate history is discussed.     

Multimodal study of pelvic splenosis: a rare cause of abdominal pain

We present a rare case of pelvic splenosis, in a 46-year-old man, with a previous history of partial splenectomy, complaining of nonspecific pain in the lower abdominal quadrants. Splenosis is a benign acquired condition, defined as a heterotopic autotransplantation of splenic tissue in other compartments of the body, caused by rupture of the splenic capsule following trauma or splenectomy. Splenosis is often asymptomatic and incidentally found and does not require treatment. Surgery is indicated only in patients presenting with symptoms or complications. In our case, the multimodal imaging study (ultrasound, MRI, CT, and scintigraphy) allowed a correct differential diagnosis without resorting to invasive procedures, susceptible to complications     

Spondylolysis as a cause of low back pain in swimmers

Low back pain (LBP) has recently become a common complaint in swimmers. The differential diagnosis of LBP in swimmers includes muscle and ligament sprains, Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and spondylolysis. Although spondylolysis or listhesis is a frequent injury in the athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet dancers, it is infrequently reported in swimmers. We have recently encountered four adolescent elite swimmers who complained of low back pain and were diagnosed as having spondylolysis. Three of the patients were either breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion in two patients. Increased uptake in bone scan was noted in all patients. CT was performed only in two patients and revealed the lesion in both. One patient was diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7 months. The patients were treated successfully by reducing the intensity of their training program and the use of a corset for at least three months. Repeated hyperextension is one of the mechanisms for spondylolysis in athletes as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers should raise the suspicion of spondylolysis. Plain radiography and bone scan should be performed followed by SPEC views, CT, or MRI as indicated. If the case is of acute onset as verified by bone scan, a Boston or similar brace should be used for 3 to 6 months in conjunction with activity modification and optional physical therapy. Multidisciplinary awareness of low back pain in swimmers, which includes trainers, sport medicine physicians, and physical therapists, should lead to early diagnosis and appropriate treatment.     

Unusual cause of persistent abdominal pain in a young girl (2006: 11a)

Interpretation Corner

Unusual cause of persistent abdominal pain in a young girl (2006: 11a)