What is it about?
Rupture of a non-parasitic splenic cyst is a rare but possibly dangerous complication with 21 cases described so far. We present a 46-year old female who presented with acute abdominal pain and was diagnosed with a spontaneous ruptured splenic cyst that was successfully treated by laparoscopic splenectomy. Histological examination showed characteristics corresponding with a non-parasitic congenital cyst that had lost its epithelial lining. Several treatment options can be considered for splenic cysts, depending on size and location. In case of rupture, the clinical condition of the patient should be taken in account. For our patient, because of the clinical and radiological findings together with the blood test results, we did not expect any severe complications. We decided that waiting was allowed and admitted her for observation. The symptoms disappeared but it was until one and half a month later that she became symptomatic again. As there were no signs of a rupture anymore, she was planned for surgery on the elective program.
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Why is it important?
• Rupture of a non-parasitic splenic cyst is a rare complication and may be life-threatening. • Symptoms can also be mild, in which case initial conservative treatment (no surgery) can sometimes be allowed. • Spleen preserving surgery is an option depending on location and size of the splenic cyst. • Our case was successfully treated by laparoscopic total splenectomy with full recovery.
Perspectives
For the ruptured non-parasitic splenic cyst, the preferred treatment depends, besides the location and size, on the clinical condition of the patient. In contrast to previous cases with a ruptured splenic cyst, we initially chose a conservative treatment strategy as the circumstances allowed this. In emergency setting with a clinically instable patient however, surgical treatment should be performed quickly. Spleen preserving surgery is theoretically possible depending on exact location and size of the cyst, but it will cost more time and it may be technically more demanding, which may be undesirable in acute setting. Depending on what is encountered, the operator has to weigh the benefits against the disadvantages to make the right decision.
Lodewijk Res
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This page is a summary of: Spontaneous rupture of a non-parasitic splenic cyst, BMJ Case Reports, October 2019, BMJ,
DOI: 10.1136/bcr-2019-231473.
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