Post-traumatic Pseudocyst of the Spleen: A Report of a Rare Case

Abstract

Splenic pseudocysts are multifactorial in etiology, with trauma being the most common causative factor, wherein an intrasplenic hematoma forms and subsequently liquefies. They can also develop as a result of infections - both local and systemic - through an inflammatory process and tissue necrosis. Pancreatitis-induced splenic pseudocysts, although exceedingly rare, arise either from the direct extension of pancreatic inflammation, enzymatic autodigestion of the pancreas, or the close anatomical relationship between the pancreas and spleen. Splenic pseudocysts are diagnosed by demonstrating their size, location, and internal septations or calcifications on imaging modalities such as computed tomography (CT) and magnetic resonance imaging. Although less sensitive than CT at discerning subtle details, ultrasonography plays a major role in initial and longitudinal monitoring, particularly due to its lack of radiation exposure, which is beneficial for certain patient populations, including pregnant or pediatric patients.

Keywords: road traffic injuries; splenic pseudocyst; splenic trauma; subcapsular splenic hematoma; total splenectomy; traumatic splenic rupture.

Figure 1. Ultrasonography of the abdomen

This image shows a large cystic lesion over the splenic region (red arrows) with laceration over the midpole of the spleen.

Figure 2. CECT of the abdomen (axial view)

This image shows gross splenomegaly with a large cystic lesion (red arrows) measuring approximately 1500 cc, with dense internal contents and a few lobulations within the splenic parenchyma at the upper and mid-pole, extending up to the subcapsular location. There is no solid component or enhancement. The cyst is seen abutting the inferior surface of the left lobe of the liver and the tail of the pancreas, with the stomach displaced to the right side, and no encasement of the splenic vessels. CECT, Contrast-Enhanced Computed Tomography

Figure 3. CECT of the abdomen (coronal view)

This image shows gross splenomegaly with a large cystic lesion (red arrows), measuring approximately 1500 cc, with dense internal contents and a few lobulations within the splenic parenchyma at the upper and mid-pole, extending up to the subcapsular location. There is no solid component or enhancement. The cyst is seen abutting the inferior surface of the left lobe of the liver and the tail of the pancreas, with the stomach displaced to the right side and no encasement of the splenic vessels. CECT, Contrast-Enhanced Computed Tomography

Figure 4. Intra-operative findings

This image shows gross splenomegaly with a pseudocyst abutting the inferior surface of the left lobe of the liver and displacing the stomach to the right side, without rupture of the cyst.

Figure 5. Intra-operative findings

This image shows gross splenomegaly with a pseudocyst and splenic injury, with no encasement of the splenic vessels. After clamping the splenic vessels at the hilar region, total splenectomy was performed.