True and Pseudocysts of the Spleen - A Diagnostic and Therapeutic Problem

Abstract

Splenic cysts are rarely diagnosed lesions. This also includes splenic pseudocysts, which usually develop as a result of a blunt abdominal cavity injury. Splenic cysts are usually diagnosed on the basis of imaging examinations, performed in case of symptomatic patients or those subject to a blunt abdominal cavity injury. material and methods. The study group comprised six patients with a positive history of blunt abdominal cavity trauma, verified by means of histopathological examinations, which were subject to surgical intervention at the Department of General and Endocrinological Surgery, Medical University in Łódź, during the period between 01. 01.2006 and 31.12.2010. Before or during the surgical procedure cystic lesions were diagnosed. The efficacy of the surgical intervention was determined. Results. Splenic pseudocysts were diagnosed in only two of the patients, although in all there was a reasonable suspicion of the above-mentioned lesion. One patient required three operations, due to recurrence of the lesion, which proved to be a primary epithelial cyst. Two of the patients required early explorative relaparotomy. Apart from the above-mentioned, treatment proved uneventful. Conclusions. The diagnosis of a splenic pseudocyst is established in case of suspicion of the above-mentioned lesion. This is evidence that in some patients focal lesions of a different nature are present, being detected by means of diagnostic imaging examinations performed after abdominal cavity injuries.

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

“…To collect the events occurring during the hospital stay or the follow-up, a binary method was used: death, secondary hemorrhage (requiring any treatment), abdominal compartment syndrome requiring surgery, infectious complication (septic syndrome, abdominal or splenic collection treated with antibiotics and/or drainage, documented pneumonia), pleural drainage, acute respiratory distress syndrome (ARDS), acute renal failure, deep venous thrombosis, splenic pseudocyst (22,23), total or near-total infarct of the spleen, pancreatitis with serum lipase levels greater than five times the normal level (24), migration of embolization material, or development of secondary splenic vascular lesion. The patients were followed up with at least one CT examination before being discharged.…”

Giant Pseudocysts of the Spleen: A Rare Sequela of Traumatic Splenic Injury

“…Because these pseudocysts are rare, diagnosis and management can be a challenge for surgeons. 1,2 This report highlights the largest posttraumatic splenic pseudocyst reported in the surgical literature.…”

“…Primary or "true" cysts contain an epithelium and can be either parasitic or nonparasitic in origin, whereas secondary or "pseudocysts" do not have an epithelial cell lining. 2 In the United States, posttraumatic pseudocysts are much more common and make up more than 75 per cent of nonparasitic cysts. 3 Pseudocysts develop when blunt abdominal trauma leads to subcapsular or interstitial hematomas.…”

“…Over time, these hematomas become encapsulated by fibrous connective tissue and liquefy into serous fluid. 2 Despite this known association, only 70 per cent of patients with pseudocysts report recent or remote abdominal trauma. 1 This finding is likely due to the insidious onset of splenic enlargement and paucity of associated symptoms, often presenting years to decades later, if at all.…”

Laparoscopic upper pole splenectomy of the simple splenic cyst

“…Morgenstern and other authors consider that surgical treatment must be done in cases of symptomatic cysts or in those with a diameter larger than 5 cm 2–4 16 17. This happens because, on one hand, they present a higher risk of complications (such as infection, spontaneous or traumatic rupture and intracapsular haemorrhage)2 and, on the other hand, a spontaneous resolution is less possible 4.…”