23-year old man with a long history of abdominal pain, nausea and vomiting: Case report of a splenic cyst

Abstract

Introduction: Splenic cysts are rare. They are usually incidentally diagnosed and there is no harmonised treatment pathway. We report a case of a large splenic epidermoid type cyst without history of previous abdominal trauma.

Presentation of case: A 23-year old male patient presented with symptoms of upper abdominal pain, nausea and vomiting. Except for a tenderness in the upper and lower left quadrant of the abdomen, the initial examination showed no extraordinary findings. A contrast enhanced computed tomography revealed a large singular splenic cyst displacing neighbouring structures. Echinococcus serology was tested negative. A laparoscopic fenestration of the superficially located splenic cyst was performed. Perioperative course was free of complications. Histopathological analysis of the excisate showed a squamous lining indicating the cyst as epidermoid type.

Discussion: Non-parasitic cyst types include traumatic, neoplastic, degenerative and congenital cysts. Due to its considerable size, our patients splenic cyst was diagnosed after occurring symptoms lead to further examination (CT scan). Laparoscopic fenestration of the cyst was chosen as the optimal surgical approach because of the superficial location of the cyst and to preserve residual splenic parenchyma. In the present case, recurrence of the splenic cyst appeared, which left the patient with a total splenectomy as the final treatment choice.

Conclusion: Due to the unspecific symptoms, the diagnosis of a splenic cyst can be prolonged. Choosing the adequate surgical technique to avoid complications is crucial. By deepening the understanding of the condition and surgical approaches, we can improve diagnostic and therapeutic management for affected patients.

Keywords: Case report; Epidermoid cyst; Laparoscopic fenestration; Spleen; Spleen preserving surgery; Splenic cyst.

Fig. 1

CT scans of the abdomen. (A). Axial view of the large hypodense cystic lesion (11 × 17 × 17 cm) in the spleen. (B). Coronal view showing the displacement of the stomach and left kidney.

Fig. 2

Intraoperative view of the splenic cyst. (A). Laparoscopic exploration and drainage of the cyst after initial incision. (B). Interior sight of the splenic cyst and remnant of fluid after laparoscopic fenestration.

Fig. 3

Tissue excisate of laparoscopic fenestration. The tissue excisate showing the irregular inner surface with the trabecular structure and knobby consistency.

Fig. 4

Histopathological examination of the splenic cyst. (A). Microscopic view of the sectioned cyst wall (Haematoxylin & Eosin staining, scale bar = 1 mm). (B). The squamous epithelial lining of the cyst wall (Haematoxylin & Eosin staining, scale bar = 50 μm).