Giant Epithelial Splenic Cyst: An Unusual Cause of Abdominal Pain in a Healthy Adolescent Male

[...]it has been hypothesized that lymph sinuses dilate abnormally, leading to cyst formation.1 The etiology of the growth and expansion of splenic cysts is still unknown, but there is evidence showing that intermittent hemorrhage of venous vessels within the cyst leads to an accumulation of fluid.2 Additional studies have suggested that the cystic fluid contains an osmotic imbalance that draws more fluid into the cyst, resulting in its expansion.2 Another possible cause of growth is the presence of stomata. Patients that report symptoms with splenic cysts usually complain of pleuritic pain, coughing, and/or a feeling of abdominal fullness.4 Physical examination may be benign or the patient may have some mild discomfort to palpation in the LUQ, so diagnosis often relies on the assistance of imaging studies. Observation is the treatment of choice for splenic cysts less than 5 cm in diameter.3 Cysts with a diameter $ 5 cm require treatment as the patient is at increased risk for cystic rupture and subsequent hemoperitoneum.3 Historically, splenectomy was the gold standard for the treatment of splenic cysts.3 Advances in laparoscopic surgery and concerns regarding the risk of overwhelming postsplenectomy infection have led to a trend toward more conservative approaches such as percutaneous or laparoscopic aspiration of cystic fluid and marsupialization, although this is only useful for smaller cysts.3 Partial splenectomy can also be an option, via either a laparoscopic or open approach, but may not be feasible for large cysts, cysts located in the splenic hilum or within the spleen, multiple cysts, or cysts that are densely adherent to surrounding structure and more than 25 per cent of the splenic tissue must be preserved to retain immunologic efficiency.