TRAUMATIC CYSTS OF THE SPLEEN - THE ROLE OF CYSTECTOMY AND SPLENIC PRESERVATION - EXPERIENCE WITH 7 CONSECUTIVE PATIENTS

Nonparasitic secondary cysts (pseudocysts) of the spleen are uncommon and usually result from blunt abdominal trauma. A 3-year experience wi th 7 consecutive cases of posttraumatic splenic pseudocysts suggests a n 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 di agnosis 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 we re no deaths or complications in the entire group. Because posttraumat ic splenic cysts are rare, the accumulation of a significant data base leading to firm conclusions is lacking. Based on a review of the lite rature and our own experience, however, the following observations and hypotheses have evolved: (1) The documentation of posttraumatic splen ic pseudocysts may become more prevalent with the widespread use of CT scanning; (2) nonsurgical management of blunt splenic injuries can th eoretically, at least, contribute to the formation of posttraumatic sp lenic pseudocysts if resolution of the injury is not followed to compl etion; (3) small asymptomatic splenic pseudocysts (<4 cm) stand a reas onable chance of involution with time (3 months-3 years), whereas larg er splenic cysts (>5 cm) require some form of interventional therapy b ecause the risk of rupture is at least 25%; (4) the 90% success rate s een with percutaneous aspiration and transcatheter drainage of intrasp lenic fluid collections may establish this treatment modality as the i nitial approach of choice when confronted with large unilocular spleni c pseudocysts; (5) when surgery is required cystectomy and splenic pre servation can almost always be accomplished with a minimal morbidity a nd no mortality.