A 14-year-old girl presented to our department for having collapsed after an acute episode of epigastric pain and vomiting. Past medical history was uneventful; in particular no previous abdominal complaints were mentioned. Physical examination showed a palpable tenderness in the epigastric region. Initially, gastroenteritis was suspected. Abdominal ultrasound revealed massive splenomegaly and in Doppler ultrasound splenic vein thrombosis was suspected. CT with CT angiography showed an enlarged, non-enhancing spleen with characteristic signs of splenic torsion (whirl sign, figure 1). Emergency laparotomy revealed haemorrhagic infarction of the spleen due to clockwise torsion of the vascular pedicle of 720° (figure 2). The spleen had no fixation to the diaphragm and the posterior abdominal wall. Thrombosis of the hilar vein and artery was confirmed and splenectomy was performed. The girl showed uneventful recovery.
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