1. PATIENT PRESENTATION
A 1‐year‐old infant presented to the hospital with a history of 3 days of nausea and anorexia, along with abdominal distention and fever for 1 day. The standing abdominal x‐ray indicated significant gastric distention with an air‐fluid level (Figure 1A). Abdominal computed tomography (CT) showed gastric distention, no spleen in the left upper quadrant, and a mass resembling the spleen under the liver compressing the pylorus (Figure 1B).
FIGURE 1.
The upright abdominal x‐ray shows a markedly enlarged stomach with an air‐fluid level (A, arrowhead). Axial computed tomography (CT) image (B) demonstrates an extremely distended stomach (arrowhead) and a displaced spleen at the liver's lower right margin (asterisk). The subsequent abdominal CT scans (C and D) show extensive free gas in the abdominal cavity (C, arrowhead). Additionally, there is a notable reduction in stomach distention and repositioning of the spleen to the upper left abdominal quadrant (asterisk).
2. DIAGNOSIS: WANDERING SPLEEN CAUSING PYLORIC OBSTRUCTION
The patient's condition worsened after 2 days of gastrointestinal decompression. Subsequent abdominal CT revealed an abundance of free gas in the abdomen, and the spleen had been repositioned (Figure 1C,D). Emergency laparoscopic surgery was performed. No perforations were detected in the gastrointestinal tract. Intraoperatively, the spleen was found to be repositioned with no signs of ischemia or twisting at its hilum. The spleen was preserved, and conservative management continued. After 2 days, the patient exhibited notable symptom improvement and was discharged.
Wandering spleen can be congenital or acquired and is characterized by absent or damaged splenic ligaments. It accounts for 0.25% of all splenectomy indications and occurs more frequently in women aged 20–40 years. 1 , 2 Children represent about one‐third of cases. 3 Wandering spleen typically settles in the pelvis due to gravitational force. Spleen movement can cause the splenic hilum to twist, leading to repeated low blood flow, infarction, and necrosis. Pyloric obstruction in this case may have been caused by the encirclement of the splenic pedicle. Laparoscopic splenectomy or splenopexy is the preferred treatments.
CONFLICT OFINTEREST STATEMENT
The authors declare no conflicts of interest.
Liu H, Qiu Y, Wang G. Unusual gastric distention in a 1‐year‐old infant. JACEP Open. 2024;5:e13124. 10.1002/emp2.13124
Contributor Information
Ya Qiu, Email: qiuy68@mail2.sysu.edu.cn.
Guojie Wang, Email: wanggj5@mail.sysu.edu.cn.
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