Splenic pseudocysts are extremely uncommon lesions of benign nature.
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Splenic pseudocysts are often secondary to the resorption of a hematomas due to previous blunt abdominal traumas.
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Sometimes it is hard to elicit a clear etiology of these cystic lesions.
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Cyst location, cyst size, and residual splenic parenchyma determine the therapeutic surgical approach.
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Partial splenectomy is the recommended procedure if at least 25% of splenic parenchyma is achievable.
Abstract
Introduction and importance
Splenic pseudocysts are extremely uncommon. Most of these cysts are asymptomatic and may result from previous blunt abdominal trauma. We report an interesting uncommon case of large splenic pseudocyst without history of previous abdominal trauma.
Case presentation
A 56 year old male patient, presented with symptoms of pain in the left side of middle back and discomfort in the left hypochondrium for few months. His physical examination was unremarkable. The abdominal Ultrasound and contrast-enhanced Computed tomography showed a large splenic cyst occupying most of the splenic parenchyma. Echinococcus multilocularis antibody test was negative. The differential diagnosis of this case included non-parasitic splenic cysts. The patient underwent elective exploratory laparoscopy which was converted to laparotomy with total splenectomy. Histopathological examination of the specimen revealed a splenic pseudocyst.
Clinical discussion
The splenic cyst in this case was symptomatic due to its large size. It was hard to elicit an etiology as there was no history of abdominal trauma, infection, or degenerative disease. The main factors in selecting either conservative or radical surgical approach for such cases are the cyst location, cyst size, and the residual splenic parenchyma.
Conclusion
The goal of splenic pseudocysts treatment is to relieve symptoms and avoid complications. Partial splenectomy is the recommended procedure when the size and location of the cyst allow preservation of at least 25% of splenic parenchyma. Otherwise, Total splenectomy is unavoidable.
