Splenic cyst following trauma, the intraoperative decision on definitive management

Abstract

Introduction Posttraumatic splenic cysts are most commonly the result of blunt force trauma to the abdomen. They usually develop from subcapsular or intraparenchymal hematomas and are typically asymptomatic. Diagnostics includes clinical history and radiological imaging procedures. Surgical treatment is the only curative modality of treatment.

Case outline A 43-year-old female patient, without comorbidities, was admitted to the health institution for additional diagnostics and surgical treatment. Laboratory test results were within the reference ranges, while serological test results for hydatid disease were negative. An abdominal CT examination was subsequently performed confirming a splenic cyst positioned in the central part of the spleen. After a laparoscopic partial pericystectomy of the cyst, we identified another smaller cyst of the spleen. According to the estimation of the surgical team, the intraoperative appearance of the remaining tissue of the spleen was less than a third of the entire spleen. The decision was taken to perform a splenectomy in the best interests of the patient, bearing in mind the possibility of complications

Conclusion Accurate diagnosis of posttraumatic splenic cysts remains a challenge, despite state-of-the-art radiological imaging procedures that are applied. In addition to the well-known modalities of treatment, the laparoscopic surgical approach, i.e., minimally invasive treatment, should be the one of choice, if the situation allows it. The laparoscopic approach is a diagnostic and therapeutic method whose effect can especially be observed when the intraoperative finding differs from the preoperative radiological finding.

Keywords: spleen; splenic cyst; laparoscopy; partial pericystectomy