Traumatic rupture of a giant congenital splenic cyst presenting as peritonitis

Abstract

Splenic cysts are uncommon, with large cysts and complications being rare. We describe a 6-year-old patient who initially presented 1 day after falling onto her abdomen at the playground with worsening abdominal pain and distention. An ultrasound of the abdomen demonstrated free abdominal fluid in all four quadrants. A subsequent contrast-enhanced computed tomography scan of the abdomen and pelvis was performed which showed a large splenic cyst with open communication to the peritoneal cavity. A congenital primary cyst was confirmed on pathology after partial splenectomy was performed. Although the majority of splenic cysts are asymptomatic, rupture can lead to acute peritoneal signs and mimic other significant causes of abdominal pain such as viscous injury or acute appendicitis.

Keywords: Child; Cyst; Laparoscopy; Peritonitis; Rupture; Spleen; Splenectomy.

Fig. 1

Gray scale ultrasound of the right lower quadrant showing a moderate to large amount of free fluid with mobile internal echoes.

Fig. 2

Axial (A) and coronal (B) contrast-enhanced CT images of the upper abdomen demonstrate a well-circumscribed, lobulated cystic lesion in the spleen. Coronal image (B) shows a communication with the peritoneal cavity through a defect within the superior aspect of the spleen. Moderate free fluid in the abdomen and pelvis was similar in density to the splenic lesion. CT, computed tomography.

Fig. 3

Five-week follow-up gray scale US of the spleen showing a mildly increasing cystic lesion within the spleen measuring 10.5 cm in maximum dimension with increasing internal echoes. Interval near complete resolution of perisplenic free fluid. US, ultrasound.

Fig. 4

Fragments of cyst wall with trabeculated red tan lining.

Fig. 5

Splenic parenchyma with cyst wall (H&E, original magnification ×40).

Fig. 6

Cyst wall lined by stratified squamous nonkeratinized epithelium (H&E, original magnification ×200).