Rare Cause of Abdominal Pain in an Adolescent Patient: Splenic Infarction in Absence of Causative Underlying Hematologic Disorder

Abstract

Splenic infarction is a rare medical condition that usually occurs in the setting of hematologic disorders. It is rarely seen in previously healthy adolescents. A wandering spleen increases the risk of splenic infarct due to risk of torsion and is more commonly seen in pregnancy due to increased elasticity of connective tissue. Wandering spleen may also be associated with diseases, such as Ehlers-Danlos, and should be suspected in the patient with possible underlying connective tissue dysfunction. Although rare, splenic infarction must be on the differential for unremitting upper epigastric pain, fever, and vomiting, particularly when patient medical history suggests connective tissue dysfunction. This case discusses the course of a pediatric patient with abdominal pain with complex medical history found to have splenic infarction secondary to torsion of a wandering spleen initially discovered on emergency CT imaging. Although rarely indicated in pediatric patients with abdominal pain, lower threshold for CT imaging for ruling out emergent etiology resulted in life-saving treatment. This case demonstrates the importance of clinical suspicion for emergency etiology of abdominal pain in pediatric patients with medical history suspicious for connective tissue dysfunction, and therefore lowering the threshold for CT imaging to rule out splenic infarction in these patients.

Keywords: child and adolescent; emergency medical service; pediatric imaging; splenic infarcts; splenic torsion.

Figure 1. CT with contrast

CT with contrast demonstrating splenic infarct secondary to torsion in a 16-year-old female patient. (A) Sagittal view with noted splenic enlargement and twisted vesicular pedicle. (B) Axial view of splenic infarction.