A 7-month-old male child was admitted under the paediatric service with 2 months history of recurrent fever not associated with rigors. The patient had similar complaints 4 months ago and was treated for upper respiratory infection. There was history of tuberculosis in the family. Clinical examination showed evidence of hepatosplenomegaly. Laboratory parameters including haematology, serum electrolytes, blood cultures, liver function tests, and chest x-ray were unremarkable except for high white cell count. The patient was evaluated and treated with IV antibiotics. However, fever persisted and an ultrasound abdomen scan revealed multiple splenic abscesses. Patient's parents were counselled and a SILS splenectomy was planned.
A surgery was carried out under general anaesthesia. Patient was placed in left upward tilt to 30  [Figure 1]. Open access transumbilical Single-incision of 3 cm was used for placement of three ports (2 x 5 mm, 1 x 10 mm) [Figure 2]. Conventional laparoscopic instruments were used [Figure 3]. The spleen was found plastered to the parietal wall with the hilum exposed, making it convenient to proceed. Splenic attachments were mobilised using harmonic scalpel and hilum was secured with Ligasure (CovidienNorwalk, CT, USA). Two splenenculi were noted and consciously preserved. Splenectomy was done and the specimen retrieved in toto through the same single-incision and sent for histopathological examination. Cavity was reinspected and haemostasis confirmed. No drain was placed. The rectus sheath was closed with 2-0 polypropylene. The incision was closed with absorbable subcuticular suture [Figure 4]. The histopathology report showed granulomatous infection [Figure 5]. Patient continued to have postoperative fever for 3 days requiring antibiotics and antipyretics and the symptoms improved. The patient was administered pneumococcal vaccine and started on antitubercular treatment as per paediatrician's recommendation. The patient was discharged on the fourth postoperative day. Postoperative follow-up at 2 weeks did not reveal any umbilical wound complication.