**5.1.2 Gastric volvulus +/- associated to splenic torsion**

The clinical picture groups together painful symptoms associated to high occlusion with vomiting. In some cases patients can be in a real state of shock.

Gastric volvulus associated to wandering spleen is a rare condition, and its quick clinical improvement with a simple medical treatment often delays the diagnosis and access to proper surgical care (Fiquet-François et al, 2010; François-Fiquet 2009; Spector & Chappell, 2000; Qazi & Awadalla, 2004). The semiological difficulty is quite real when faced with complex clinical pictures associating gastric volvulus, wandering spleen and even in some cases a diaphragmatic hernia (Liu & Lau, 2007).

The combination of wandering spleen and gastric volvulus should be explored by additional imaging exams, and requires a quick and adapted therapeutic care.

### **5.2 Chronic clinical picture**

Between 39% and 43% of children treated for wandering spleen had already presented similar symptoms. (Brown et al, 2003; Fiquet-François et al, 2010). Most often these children had been complaining about non-systematic recurrent but inconsistent abdominal pain for the past months (even several years). Some children were even hospitalized several times before making a proper diagnosis. This is mostly due to the quick clinical improvement when the child was lying down (Fiquet-François et al, 2010; François-Fiquet et al, 2009). The chronic clinical picture once again underlines the difficulty in making a proper diagnosis when faced with an atypical clinical picture.
