S3434 Gastric Compression Due to Splenic Cyst

Abstract

INTRODUCTION: Splenic cyst have a very low overall incidence of 0.07% out of which 0.5% across the splenectomy patient population and a further 0.08% diagnosed at autopsy. The primary epithelial cysts account for 10% of all splenic cysts. CASE DESCRIPTION/METHODS: 25 year old Caucasian female no past medical history complains of epigastric and left upper abdominal pain associated with nausea, multiple episodes of post-prandial vomiting and diarrhea for 3 weeks. CT abdomen suggested cystic splenic mass 10.1 cm in the anterior portion most likely a splenic epithelial cyst or splenic pseudocyst that was compressing the stomach. Further studies of Echinococcosis IgG, CMB/ EBV, stool ova & parasite, AFB serologies were negative, Interventional radiology performed fine needle aspiration with pig tail catheter placement. Cultures of the aspirate was positive for Enterococcus Casseliflavus, Staph. Xylosus and Enterobaccter cloacae and was treated with antibiotics. Upon resolution of the size of the cyst, stomach was distended and patient was able to tolerate PO diet. Due to persistent drainage, patient underwent cyst sclerotherapy without complication with good outcome. DISCUSSION: Splenic Cysts are asymptomatic in 30% to 60% of patients and most are diagnosed incidentally. Small (8 cm) are more likely to produce symptoms.They are Type I primary or “true” cysts and Type II secondary splenic cysts or pseudocysts. Type I splenic cysts re defined by the presence of an epithelial lining. They include both parasitic and nonparasitic etiologies.Up to 80% of nonparasitic cysts are found in patients younger than age 20 years, suggesting a congenital origin. Parasitic cysts of the spleen are caused by Taenia echinococcus, most often E. granulosus. Earlier, total splenectomy was the treatment of choice; now, splenic preservation, including partial splenectomy, cystectomy, and cyst decapsulation is becoming more commonly used. Other treatment options include (1) drainage via radiologic guidance and (2) total splenectomy. Due to the complex presentation of the splenic cyst there is only few evidence-based management and treatment regimens. Most cysts can be treated via partial and total splenectomy however splenic conservation procedures should be the focus for the future treatment.Figure 1