A rare case of splenic hematoma following chronic pancreatitis--the diagnostic and therapeutic procedures

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.

A rare presentation of splenic tuberculosis with a pseudocyst

Splenic tuberculosis is an unusual manifestation of extrapulmonary tuberculosis, especially in immunocompetent hosts. It often poses diagnostic difficulties as microbiological confirmation is not easy. In this case report, we describe a case of pseudocyst of the spleen due to tuberculosis, which is a rare clinical presentation with only one case having been reported previously. A 24-year-old immunocompetent woman presented with pain in the abdomen, vomiting and fever. On evaluation the patient was found to have a cyst arising from the spleen. Splenectomy was performed. Pathological examination of the specimen revealed a pseudocyst with granulomas and giant cells consistent with tuberculosis. Cyst fluid analysis revealed lymphocyte predominance with high adenosine deaminase levels. The patient was started on 6 months of antituberculous therapy postoperatively. On follow-up, the patient was found to have gained weight and showed signs of well-being.

Pseudocyst of the spleen caused by tuberculosis: a rare entity

Splenic cysts can be primary or secondary, depending upon the aetiology and pathology. Secondary cysts can be of inflammatory, infective, degenerative or traumatic aetiology. Splenic cysts can be true (lined by epithelium) or secondary (pseudocyst, not lined by epithelium). True splenic cysts are mainly congenital and pseudocysts are mainly traumatic in origin. Pseudocyst of the spleen due to tuberculosis is extremely rare .We report one such case of pseudocyst of the spleen caused by tuberculosis together with a relevant review of literature. Our case probably represents the first reported case of tubercular pseudocyst of the spleen.