Symptomatic large epithelial splenic cyst mimicking post-traumatic pseudocyst: a surgical case report

Introduction: Splenic cysts are uncommon lesions, broadly classified into true (epithelial-lined) and false (pseudocyst) categories. Secondary splenic cysts, often resulting from trauma, are typically presumed in patients with a history of blunt abdominal injury. Presentation of case: We present a case of a 34-year-old male with a large splenic cyst incidentally discovered more than a decade after remote abdominal trauma. Imaging and history favored a diagnosis of post-traumatic pseudocyst, leading to spleen-preserving cystectomy. Histopathological analysis unexpectedly revealed an epithelial-lined primary splenic cyst. Clinical discussion: This case emphasizes the limitations of imaging in differentiating cyst types and the importance of histopathology for accurate diagnosis. It also supports spleen-conserving surgical approaches when the cyst morphology permits. Conclusion: While trauma-based pseudocyst was suspected, histopathology confirmed an epithelial cyst. Spleen-preserving surgery with follow-up is a sound strategy in such cases.