English

Abstract

A 19 years-old male who presented with upper abdominal discomfort of one-year duration. Imaging revealed a huge splenic cystic. Splenectomy was undertaken. Pathological examination revealed an epidermoid cyst. INTRODUCTION: Splenic cysts are an uncommon encounter in surgical practice and less than 1000 cases have been reported [1,2]. Most patients with splenic cysts experience minor, nonspecific symptoms related to the mass effect of the cyst. The diagnosis is made by taking a thorough patient history, conducting a physical examination, and evaluating ultrasonography. Rupture, haemorrhage, and infection, which may be life-threatening, have been reported [3]. CASE REPORT: A19yrs old male patient, student, non-smoker, presented with upper abdominal discomfort and dull pain in left upper abdomen of one year duration. The patient had no history of trauma. On examination, there was a single, cystic, non-ballotable intra-abdominal lump in the left hypochondrium that moved with respiration. The routine biochemical and hematological investigations were normal. Spleen was enlarged reaching upto the umbilicus. Ultrasound showed a huge splenic cyst, which had two components; an upper multilocular component and a lower unilocular one. Laboratory tests were normal. Injection Pnemovac was given 2 weeks prior to surgery. Exploratory laparotomy was undertaken. The spleen was huge (Figure 1 & 2) and toughly adherent to the posterior abdominal wall. It was almost completely replaced with the cyst but the wall or splenic rim of tissue was thick. Tortuous dilated veins were found at the hilum. After freeing the adhesions with blunt dissection delivery of the spleen was done, control of the splenic artery and vein through lesser sac secured further dissection, mobilization and extraction. The patient had an uneventful postoperative course. Pathological examination revealed an epidermoid cyst. DISCUSSION: The treatment of splenic cysts is a difficult challenge to surgeons [4]. Not surprisingly with the classification, diagnostic modalities and treatment guidelines are far from being uniform or clear. Three classification systems are present Fowler, Martin and Morgenstern [5]. Discovery of the cyst is easy with imaging modalities but the true nature and pathology of the cyst is not always possible to determine preoperatively [6]. Since the pathology dictates management, decision making for the ultimate management is still personal. Preoperative aspiration of the fluid for biochemical and cellular examination is debatable. Some recommend it routinely [4] while others see it is contraindicated and hazardous [2]. A wide range of treatment modalities have been described for symptomatic or very large cysts of the spleen. Non operative measures, such as observation, have been recommended for asymptomatic cysts smaller than 5 cm. The natural history of these small cysts is largely unknown,