Laparoscopic fenestration of a symptomatic giant splenic cyst in a young adult: A case report

TL;DR

A young adult with a large, symptomatic splenic cyst was successfully treated with laparoscopic surgery that preserved the spleen.

Contribution

This case highlights laparoscopic fenestration as a safe, spleen-preserving treatment for giant symptomatic splenic cysts.

Findings

Laparoscopic fenestration resolved symptoms and preserved splenic function in a 25-year-old male.

MRI and aspiration helped confirm the benign nature of the cyst before surgery.

The patient remained asymptomatic with no complications at follow-up.

Abstract

Splenic cysts are rare lesions typically discovered incidentally through imaging. While many are asymptomatic, large or symptomatic cysts may require surgical intervention to avoid complications. Advances in surgical technique and recognition of splenic function have shifted treatment from routine splenectomy toward organ-preserving approaches.

A 25-year-old male presented with early satiety, nausea, intermittent vomiting, and persistent left shoulder pain. Imaging revealed a 15 cm unilocular splenic cyst incidentally discovered during a Computed Tomographic Angiography (CTA) for asthma exacerbation. Magnetic Resonance Imaging (MRI) findings favored a chronic hematoma or epithelial cyst. Interventional radiology (IR)–guided aspiration ruled out malignancy or infection. Due to persistent symptoms and lesion size, the patient underwent laparoscopic fenestration. Pathology confirmed a benign fibrous cyst wall and splenic debris. The postoperative course was uneventful, and the patient remained asymptomatic at follow-up.

Nonparasitic splenic cysts are rare and often incidentally discovered. While frequently asymptomatic, large cysts can cause nonspecific symptoms and present diagnostic challenges. Imaging and aspiration may guide management, but definitive surgical intervention is often required due to recurrence risk and inconclusive findings. Laparoscopic fenestration allows for effective treatment while preserving splenic function, minimizing morbidity, and long-term immunologic risks.

Laparoscopic fenestration is a safe and effective treatment for symptomatic giant splenic cysts. In appropriately selected patients, spleen preservation can be achieved with favorable outcomes and minimal complications.

•Rare case of a giant splenic cyst discovered incidentally on CTA.•Symptomatic presentation with shoulder pain, satiety, and nausea.•MRI supported a differential including chronic hematoma or pseudocyst.•Successful laparoscopic fenestration with spleen preservation.•Multidisciplinary evaluation guided surgical management.

Rare case of a giant splenic cyst discovered incidentally on CTA.

Symptomatic presentation with shoulder pain, satiety, and nausea.

MRI supported a differential including chronic hematoma or pseudocyst.

Successful laparoscopic fenestration with spleen preservation.

Multidisciplinary evaluation guided surgical management.

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