Pregnancy complicated with a giant splenic cyst: a case report and review of the literature

Splenic cysts or masses in pregnancy are extremely rare and only five cases were described in the literature. We present the first case of splenic cyst in pregnancy treated laparoscopically with fenestration and preservation of the spleen. A 23-year-old primigravida at 9 weeks of gestation presented for her prenatal follow-up with a 3 weeks history of epigastric pain and early satiety. A magnetic resonance imaging of the abdomen and pelvis demonstrated a gigantic splenic cyst measuring 17 x 13 x 15 cm. Aspiration of the cyst was performed under ultrasound guidance for diagnostic purposes as well as for relief of patient's symptoms. The patient was followed by bi-weekly sonographic scan until the second trimester. A second aspiration of the cyst was complicated with sepsis, and laparoscopic fenestration and omentopexy were performed. The patient's remaining antepartum course was uncomplicated and she had a normal spontaneous delivery at thirty-eighth week. The most feared complication of a splenic cyst in pregnancy is spontaneous rupture, which in the third trimester is associated with a perinatal mortality rate as high as 70%. Surgical therapy should therefore be provided in the second trimester. Laparoscopic fenestration with omentopexy is a minimally invasive, effective and safe procedure for this condition.