Unusual pseudocyst in a wandering spleen

Abstract

Pseudocysts of the spleen are rare, generally asymptomatic lesions developing secondary to trauma, infection or infarction. When symptomatic, they typically present as non-specific pain in the left hypochondrium, with or without a palpable lump on clinical examination. However, these conventions fail when they occur in a wandering spleen, making imaging critically important. This report describes an unusual case of a 50-year-old who presented with a large cystic mass in a pelvic spleen; imaging facilitated a successful splenectomy and subsequent histopathology revealed a pseudocyst in a wandering spleen.

A congenital wandering spleen with a large epithelial cyst: A case report

“…The wandering spleen with a large cyst was located in the left lower quadrant of abdomen and there was fluid collection in the peritoneal cavity epithelial lining in utero during the perinatal period, which progresses to epithelial cysts and may coexist with abnormal development of ligaments leading to the congenital wandering spleen. 6,7,9,10,12 History taking and physical examination are the primary tools for making an initial impression. Some patients may be asymptomatic or complain of mild intermittent pain because splenic congestion varies with intermittent torsion and spontaneous detorsion.…”

“… 4–10 But only 5 cases among them had the wandering spleen with splenic true cyst 4–8 . Manoharan et al reported a wandering spleen with a cyst, but the cyst was a pseudocyst 9 . And Nawaz et al also reported a wandering spleen with a cyst in a neonate, and they did partial splenectomy and splenopexy 10 .…”

“…History taking and physical examination are the primary tools for making an initial impression. Some patients may be asymptomatic or complain of mild intermittent pain because splenic congestion varies with intermittent torsion and spontaneous detorsion 7,9,12 . Abdominal ultrasonography or CT is the primary imaging modality 11 .…”

“…[4][5][6][7][8] Manoharan et al reported a wandering spleen with a cyst, but the cyst was a pseudocyst. 9 And Nawaz et al also reported a wandering spleen with a cyst in a neonate, and they did partial splenectomy and splenopexy. 10 But the splenic cystic degeneration was caused by infarction of the lower pole of the spleen due to intrauterine torsion of splenic vessels.…”

“…Some patients may be asymptomatic or complain of mild intermittent pain because splenic congestion varies with intermittent torsion and spontaneous detorsion. 7,9,12 Abdominal ultrasonography or CT is the primary imaging modality. 11 CT contrast imaging is very helpful to identify the morphology of cysts and abnormal position of the spleen, with or without torsion in the abdomen or pelvis.…”