AB187. SOH25_AB_230. Traumatic rupture of a primary splenic cyst in a young male: a case report

Background: Splenic cysts are a rare pathology with hemodynamical instability due to rupture even rarer. We present the case of a 16-year-old male patient with a large undiagnosed splenic cyst that subsequently ruptured due to abdominal trauma sustained during boxing practice.

Case Description: A 16-year-old male patient presented with syncope and sudden-onset abdominal pain following boxing practice. On clinical examination, the patient was tender with guarding in the left upper quadrant. He was managed in accordance with advanced trauma life support (ATLS) guidelines, and a focused assessment with sonography for trauma (FAST) scan revealed free fluid in the abdomen. Computed tomography (CT) revealed a 13 cm splenic cyst that contained haemorrhage. Due to haemodynamic stability, initial management was conservative with close monitoring in the high dependency unit (HDU). After 72 hours, the patient developed haemodynamic instability, and further CT imaging demonstrated enlargement of the cyst from 14 to 15 cm. Decision was then made for surgery, and a laparotomy and total splenectomy were performed. The definite histopathological diagnosis was benign splenic cyst with haemorrhage. Post-operatively, he recovered in the intensive care unit (ICU) and made a full recovery.

Conclusions: This case of splenic cyst is the largest documented in current literature and presentation with rupture, with no prior diagnosis, is even rarer. The patient was managed according to existing guidelines for splenic trauma. The importance of this case is to inform the necessity of guidelines for treatment of the pathological spleen by incorporating current guidelines on management of splenic trauma.

Keywords: Splenic cyst; splenic trauma; splenectomy; case report