Laparoscopic splenectomy for large splenic pseudocyst: A rare case report and review of literature

A Giant Non-Traumatic Splenic Pseudocyst Successfully Treated With Cyst Aspiration and Partial Cystectomy: A Case Report and Review of Literature

Splenic cysts are extremely rare entities that typically result from prior abdominal trauma, infections, and degenerative diseases. They are divided into two categories: true cysts with epithelial lining, and false pseudocysts without epithelial lining, which is more common than true cysts. We describe here a case of a non-traumatic splenic pseudocyst in a healthy 29-year-old male patient, who presented with left upper quadrant abdominal pain. Physical examination revealed scaphoid abdomen and left hypochondrium fullness. The spleen was uniformly enlarged, smooth, and firm, with mild tenderness. Laboratory testing was normal. An abdominal CT scan showed a huge unilocular non-enhancing cyst occupying the upper part of the spleen, measuring around 16 × 18.5 × 20 cm. The patient was managed with cyst aspiration and partial cystectomy. The histopathological examination findings are consistent with splenic pseudocyst. A one-year follow-up period revealed no complications or recurrence. Spleen cysts are rare in clinical practice, posing challenges in diagnosis and treatment. Surgical options include partial or total splenectomy, cyst aspiration, percutaneous drainage, partial cystectomy, and marsupialization. The choice depends on the cyst's size, splenic coverage, and relation to the hilum. Recently, spleen-preserving approaches have been favored to avoid life-threatening sepsis. Non-traumatic splenic pseudocysts present significant diagnostic dilemmas, requiring histopathological examination for definitive diagnosis. Spleen-preserving management is highly recommended to reduce the risk of life-threatening sepsis.

Massive splenic cyst in pregnancy: case report

BACKGROUND

Primary splenic cysts are very rarely diagnosed in pregnancy, with only thirteen cases described in the literature. We examine the approach towards diagnosing and managing uniquely large abdominal masses that significantly complicate obstetric care.

CASE PRESENTATION

A 37-year-old primigravida woman presented with abdominal distension and discomfort, yet otherwise asymptomatic. On ultrasound, an incidental pregnancy at 25 weeks of gestation and a large pelvic lesion were discovered. MRI defined a 28 × 29 cm lobulated, complex cystic mass in the upper abdomen. The patient underwent two ascitic drainages throughout her pregnancy. At 34 weeks of gestation, she had a classical caesarean section. Then at five-weeks postpartum, she underwent a laparotomy and total splenectomy with 16 L of fluid drained. Histopathological analysis revealed an epithelial cyst of the spleen. Her recovery was complicated by complete portal vein thrombosis.

CONCLUSION

This case describes the largest splenic cyst ever reported in pregnancy and explores the diagnostic dilemmas and treatment challenges associated. We introduce the utility of serial ascitic drainages in prolonging the pregnancy and emphasise the reliance on imaging for surveillance of splenic size and fetal wellbeing.

Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

BACKGROUND

Atraumatic splenic rupture (ASR) accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. The most common culprit is acute infection with Epstein-Barr virus (EBV) but other documented aetiologies include neoplasia, other viral/bacterial infections, acute and chronic pancreatitis, amyloidosis and anticoagulant medications. There are four previous reports of cocaine-associated ASR but never before has it been documented in combination with concurrent acute EBV infection.

CASE SUMMARY

A 21-year-old man presented to hospital with acute left shoulder pain which radiated to the right shoulder and upper abdomen. He denied any history of recent trauma and had no relevant past medical history. He took no regular prescription medications but had used cocaine within the previous 24 h. Investigations revealed splenomegaly, a Grade 3 subcapsular splenic haematoma, moderate haemoperitoneum and an incidental 9 mm splenic artery pseudoaneurysm. There was also serological evidence of acute EBV infection. Prophylactic endovascular embolisation of the pseudoaneurysm was performed and the splenic rupture was managed non-operatively. The patient remained admitted in hospital for seven days and did not require any transfusion of blood products. Serial imaging showed complete resolution of the haemoperitoneum after 5 wk. The importance of abstinence from illicit drug use was emphasised to the patient but it is unknown whether or not he remains compliant.

CONCLUSION

This case demonstrates that ASR is a rare condition that can result from acute EBV infection and cocaine ingestion and requires a high index of suspicion to diagnose clinically.

Epidermoid Cysts in a Wandering Spleen: An Unusual Enigma

Epidermoid splenic cysts are rare lesions in the spleen. These cysts are characterized by a stratified squamous epithelial lining, internal septations, and calcification. Congenital in origin, epidermoid splenic cysts are postulated to arise from misfolding and mesothelial cell incorporation into the splenic parenchyma. This report presents a unique case of an 18-year-old woman with an epidermoid splenic cyst in a congenital wandering spleen. Computed tomography and transabdominal ultrasound imaging along with immunochemistry staining confirmed the diagnosis. To the authors' knowledge, this is the first reported case of an epidermoid cyst in a wandering spleen.