Traumatic pseudocyst of the spleen

Large expanding splenic pseudocyst: A case report and review of literature

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.

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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.

True and pseudocysts of the spleen - a diagnostic and therapeutic problem

Splenic cysts are rarely diagnosed lesions. This also includes splenic pseudocysts, which usually develop as a result of a blunt abdominal cavity injury. Splenic cysts are usually diagnosed on the basis of imaging examinations, performed in case of symptomatic patients or those subject to a blunt abdominal cavity injury.

MATERIAL AND METHODS

The study group comprised six patients with a positive history of blunt abdominal cavity trauma, verified by means of histopathological examinations, which were subject to surgical intervention at the Department of General and Endocrinological Surgery, Medical University in Łódź, during the period between 01.01.2006 and 31.12.2010. Before or during the surgical procedure cystic lesions were diagnosed. The efficacy of the surgical intervention was determined.

RESULTS

Splenic pseudocysts were diagnosed in only two of the patients, although in all there was a reasonable suspicion of the above-mentioned lesion. One patient required three operations, due to recurrence of the lesion, which proved to be a primary epithelial cyst. Two of the patients required early explorative relaparotomy. Apart from the above-mentioned, treatment proved uneventful.

CONCLUSIONS

The diagnosis of a splenic pseudocyst is established in case of suspicion of the above-mentioned lesion. This is evidence that in some patients focal lesions of a different nature are present, being detected by means of diagnostic imaging examinations performed after abdominal cavity injuries.

Non-parasitic splenic cysts

This article gives an overview of the topic, with emphasis on current concepts and management of the clinical situations in question, in particular the concepts related to treatment. An extensive review of the etiology and monitoring of patients with non-parasitic splenic cysts is also made. These reports are derived from major clinical studies published in the current medical literature.

Can this spleen be saved? From complications to vaccinations, know the latest management techniques for splenic trauma

From complications to vaccinations, know the latest management techniques for splenic trauma.

Management of splenic pseudocysts following trauma: a retrospective case series

BACKGROUND

Post-traumatic splenic pseudocysts are uncommon. The optimal treatment is not well defined.

METHODS

A retrospective chart review was conducted at the three adult hospitals in the Calgary Health Region.

RESULTS

Six cases of splenic pseudocysts were found over a 6-year period. One splenic pseudocyst spontaneously resolved. A second splenic cyst was removed by open splenectomy. The remaining 4 patients were all first treated with percutaneous drainage. However, 3 of the 4 cysts recurred. Two of these 3 recurrent cysts were treated with laparoscopic fenestration, and all subsequently recurred; 1 of these patients later developed a splenic abscess. The third patient had a repeat percutaneous drain with subsequent recurrence. The last patient died of sepsis secondary to an iatrogenic punctured colon.

CONCLUSIONS

Percutaneous drainage and laparoscopic fenestration have an unacceptably high rate of failure. Partial or complete splenectomy should be considered for young and otherwise healthy patients who have large symptomatic splenic pseudocysts.