Giant Splenic Pseudocyst in an Adult Patient: A Case Report

Splenic pseudocysts represent an uncommon condition in abdominal surgery, generally resulting from trauma, infection, or ischemic processes. Histologically, they are characterized by the absence of an epithelial lining; that is, they lack the inner layer of cells typically found in true cysts. Its clinical presentation is non-specific, commonly manifesting with abdominal pain, early satiety, or alterations in bowel habits, which lead to late or incidental diagnoses through imaging studies. We present a case of a 40-year-old male patient with chronic digestive symptoms of three years' evolution. After multiple medical consultations without a definitive diagnosis, a CT scan was performed that revealed a giant splenic cystic lesion measuring 15 × 20 cm, with a compressive effect on adjacent abdominal structures. Laparoscopic total splenectomy was indicated, preceded by pneumococcal and meningococcal vaccination. The intervention was performed without complications, and the patient was discharged 24 hours later with a satisfactory clinical evolution. The macroscopic study of the spleen showed a 20 x 15 cm unilocular cystic lesion with necrotic content, and histopathological analysis confirmed the diagnosis of splenic pseudocyst. This case was compared with a similar report in the literature, where a patient with a comparable lesion was treated by open splenectomy, also obtaining a favorable result. Both cases highlight the importance of maintaining a high index of suspicion in the face of non-specific abdominal symptoms and the usefulness of imaging as a diagnostic tool. They also reinforce the role of splenectomy, especially laparoscopically, as a safe and effective treatment in large lesions, always under a multidisciplinary approach and with adequate preventive immunological management.