TRAUMATIC CYSTS OF THE SPLEEN—THE ROLE OF CYSTECTOMY AND SPLENIC PRESERVATION

Abstract

Nonparasitic secondary cysts (pseudocysts) of the spleen are uncommon and usually result from blunt abdominal trauma. A 3-year experience with 7 consecutive cases of posttraumatic splenic pseudocysts suggests an increased prevalence of this clinical entity. This report describes 7 adult patients (5 men and 2 women) with a mean age of 32 years, all of whom sustained relatively minor trauma within 5 years of admission. Persistent epigastric or left upper quadrant pain led to a CT scan diagnosis of splenic cysts that varied in size from 7 cm to 15 cm. Each patient underwent resection of the cyst-bearing portion of the spleen with preservation of the remaining normal splenic parenchyma. There were no deaths or complications in the entire group. Because posttraumatic splenic cysts are rare, the accumulation of a significant data base leading to firm conclusions is lacking. Based on a review of the literature and our own experience, however, the following observations and hypotheses have evolved: (1) The documentation of posttraumatic splenic pseudocysts may become more prevalent with the widespread use of CT scanning; (2) nonsurgical management of blunt splenic injuries can theoretically, at least, contribute to the formation of posttraumatic splenic pseudocysts if resolution of the injury is not followed to completion; (3) small asymptomatic splenic pseudocysts (<4 cm) stand a reasonable chance of involution with time (3 months-3 years), whereas larger splenic cysts (>5 cm) require some form of interventional therapy because the risk of rupture is at least 25%; (4) the 90% success rate seen with percutaneous aspiration and transcatheter drainage of intrasplenic fluid collections may establish this treatment modality as the initial approach of choice when confronted with large unilocular splenic pseudocysts; (5) when surgery is required cystectomy and splenic preservation can almost always be accomplished with a minimal morbidity and no mortality.