July 21st, 2018

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Giant Splenic Cyst in a Third Trimester Pregnancy: A Case Report
Authors:  Jillian Kurtz, D.O., James Kurtz, D.O., Jennifer Papp, D.O., and Stephen Glatz, M.D.
BACKGROUND: Splenic cysts in pregnancy are extremely rare, with only 9 cases reported as of 2014. The optimal treatment of this rare condition is not well defined, and recommendations are based on retrospective review of limited case studies. We present a case of a giant splenic cyst presenting in the 39th gestational week of pregnancy.

CASE: An 18-year-old woman, G1P0, at 392/7 weeks’ gestation presented to labor and delivery triage complaining of symptoms related to a urinary tract infection. A renal ultrasound was obtained to assess for hydronephrosis and incidentally revealed a splenic cyst measuring up to 20 cm. Maternal-Fetal Medicine recommended vaginal delivery with care to avoid fundal pressure and decrease likelihood of rupture. After failed induction due to arrest of dilation, the patient underwent a cesarean section followed by splenectomy.

CONCLUSION: The most feared complication of a splenic cyst in pregnancy is splenic rupture. Sixty percent of ruptures occur in the 3rd trimester, and 70% of those are associated with perinatal mortality. Current literature suggests that intervention (laparoscopic splenectomy versus fenestration) should take place in the second trimester to avoid complication. There have not been any cases reported of a giant splenic cyst at 39 weeks’ gestation, and best management practices are yet to be determined.
Keywords:  cesarean section, cysts, pregnancy complications, splenectomy, splenic rupture
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