Esplenectomia pós trauma com achado intraoperatório de lesão tumoral cística em pediatria

• DOI: https://doi.org/10.22533/at.ed.820811225251110

• Palavras-chave: Trauma. Cisto epidermóide. Baço. Esplenectomia.

• Keywords: Spleen. Epidermoid cyst. Splenectomy. Trauma.

• Abstract: Splenic cysts are rare alterations that affect the spleen, often detected incidentally on imaging exams. They can be congenital or acquired, classified into true cysts or pseudocysts. Most epidermoid cysts have a congenital or neoplastic character, while pseudocysts are a consequence of a blunt trauma. The diagnostic hypothesis will arise after routine physical and radiological exams. This report presents the case of a child submitted to splenectomy after closed abdominal trauma with an anatomopathological result of epidermoid cyst. Report: S.R.S., male, 9 years old, presented abdominal trauma during physical activity, with onset of diffuse abdominal pain of strong intensity, without irradiation, associated with vomiting and loss of consciousness. He underwent abdominal radiography suggesting splenic injury, without active bleeding; ultrasound and total abdominal tomography confirming expansive rounded lesion, cystic, with solid components and epicenter in the spleen. He evolved with hematimetric drop and abdominal distension, opting for surgical intervention with exploratory laparotomy. Intraoperatively, a large amount of blood and a giant cystic tumor lesion associated with splenic rupture were observed, performing total splenectomy. Discussion: In the scenario of splenic cysts, post-traumatic ones predominate. Most are asymptomatic; symptomatic patients present pain in the left hypochondrium, epigastrium, and periumbilical region, associated with nausea, vomiting, and postprandial fullness. The diagnosis is made through histopathological examination; for differential diagnosis, computed tomography and abdominal ultrasonography are used. Conservative management is valid for small asymptomatic cysts, and partial splenectomies and decapsulation are also effective. Surgical treatment is splenectomy, useful in preventing complications (cyst rupture, acute abdomen, infections). In the studied case, splenectomy was chosen due to the size of the cyst, symptoms, and general condition of the patient.