SUR11 Laparoscopic management of recurrent post traumatic splenic pseudocyst: Case report. (Surgery).

SUR11 LAPAROSCOPIC MANAGEMENT OF RECURRENT POST TRAUMATIC SPLENIC PSEUDOCYST: CASE REPORT. Jonathan Smith, MD, CPT, MC, Anthony Laporta, MD, COL, MC. Department of General Surgery, Evans Army Community Hospital, Fort Carson, Cob.

Pseudocysts of the spleen are rare but usually arise after blunt abdominal trauma. The purpose of this review is to present the case of a recurrent posttraumatic splenic pseudocyst, three years after initial injury, and its laparoscopic management. The patient is a 22-year-old female who three years prior to presentation to our facility, received blunt abdominal trauma during sports related activities. Three months after the initial injury, she developed a splenic pseudocyst, which was managed by laparoscopic marsupialization. Three years later, a large left upper quadrant mass developed, but she was otherwise asymptomatic. A preoperative CT documented a 24 cm splenic cyst with significant mass effect. She then underwent laparoscopic exploration, cyst decompression, and splenic cystectomy. Several intraoperative photographs were taken. 1600 cc of green fluid were obtained. A 7 mm Blake drain was placed within the cyst cavity and was discontinued on postoperative day 4. CT on postoperative days 1 and 10 did no t demonstrate cyst recurrence. Literature review shows that these cysts are rare. Most pseudocysts arise after splenic trauma from liquefaction of splenic hematomas. Treatment options include percutaneous drainage, marsupialization, cystectomy, and splenectomy. External drainage and marsupialization have an unacceptable rate of infection, bleeding, and reaccumulation, and are inadequate modalities of treatment. Splenic preservation is preferred, but splenectomy may be necessary for uncontrollable hemorrhage or possible malignancy. Small cysts may effectively be managed with percutaneous drainage, however, cystectomy is the preferred management for larger cysts. Splenic pseudocysts are a rare complication of splenic trauma. We present the case of a recurrent posttraumatic splenic pseudocyst managed by laparascopic cystectomy. Several methods of treatment exist, but splenic preservation is preferred.