PMC3407447_01
Reformatted coronal view, CT scan of the abdomen pelvis. Note the nonanatomic location of the spleen in the left lower quadrant and mild heterogenicity of flow noted at the cephalad portion.
jls0011228450001.jpg
PMC3407447_01_jls0011228450001.jpg
F1
Her pain had recently begun to worsen, and she presented to our medical center where a computed tomography (CT) scan of her abdomen showed a change in normal splenic configuration with mild heterogenicity of flow (Figure 1).
Axial view, CT scan of the abdomen. Note the nonanatomic position and clockwise rotation of the spleen. The white arrow denotes the characteristic whirl sign, pathognomonic for torsion of the vascular pedicle.
jls0011228450002.jpg
PMC3407447_01_jls0011228450002.jpg
F2
A repeat CT scan showed interval torsion of the spleen with 90-degree rotation in a clockwise configuration with associated vascular torsion and attenuation of the spleen consistent with congestion and descent of the spleen into the left lower quadrant (Figure 2).
Delivery of the spleen into the wound with splenic rupture noted at the inferior pole.
jls0011228450003.jpg
PMC3407447_01_jls0011228450003.jpg
F3
The gastrocolic ligament was taken down, and when the spleen was delivered into the wound (Figure 3), splenic rupture was noted on the inferior pole.
On delivery of the spleen, the vascular pedicle was de-torsed, and the spleen immediately decongested. A small amount of hemoperitoneum was noted immediately upon entering the abdomen.
jls0011228450004.jpg
PMC3407447_01_jls0011228450004.jpg
F4
The spleen itself was also very enlarged and congested but immediately became smaller and pale when detorsion of the vascular pedicle was performed (Figure 4).