Beyond the immediate: Splenic pseudocyst as a rare delayed complication of blunt abdominal trauma: A case report

Splenic pseudocysts are an extremely uncommon condition. Cysts of the spleen can be categorized into parasitic and non-parasitic. Most of these cysts are asymptomatic. We report a fascinating unusual case of a giant splenic pseudocyst developed secondary to past abdominal trauma. A 47-year-old gentleman presented with a gradually progressive abdominal lump in left upper abdomen for the past four months associated with dull aching pain with a history of blunt trauma abdomen one year back. On examination, 25 X 18 cm non tender swelling was present in the left hypochondrium, extending up to the umbilicus. Ultrasonography and CECT Abdomen showed a well-defined non enhancing hypodense lesion of size 16X14X21 cm in spleen. Hydatid serology was negative, but he was found to have JAK 2 mutation. Patient was taken up for laparotomy in which 26X19X13 cm of spleen was removed which was adherent to the left dome of the diaphragm. Excision of spleen created a rent in diaphragm which was managed by primary repair with mesh placement and left ICD insertion. Excised cyst of the spleen was filled with around 2.5 liters of pus and histopathology report confirmed the diagnosis of pseudocyst of spleen. Huge size of splenic pseudocyst produced symptoms in this case. Such cases can be managed with either conservative or radical surgical approach. Treatment can be individualized on the basis of cyst location, cyst size, and the residual splenic parenchyma. The aim of splenic pseudocysts management is prompt diagnosis, symptomatic relief and prevent complications. Management varies from cyst aspiration to splenectomy.