Background Splenic cysts are rare entities. There are approximately 1000 cases reported in the literature, with an estimated incidence of 0.07%. Congenital cysts, corresponding to nearly 2.5% of all splenic cysts, are more frequent in female children and young adults. Usually they are asymptomatic sole lesions, discovered incidentally during imaging studies. Often the patients present with an abdominal mass associated with mild symptoms related to cyst enlargement.

Complications occur in 15–20% of cases (infection, rupture, hemorrhage). Imaging studies have an important role in diagnosis (ultrasound, CT scan, MRI) but definitive diagnosis is established by anatomopathology. In most cases conservative management is reasonable. For symptomatic or larger cysts (more than five centimetres) surgery is warranted.

Case Report A ten-year-old female child, otherwise healthy, presented with diffuse abdominal pain after minor toraco-abdominal trauma. On examination she was pale, with no significant hemodynamical alterations. The abdomen was diffusely painful to palpation with peritoneal reaction. On analytical evaluation, haemoglobin 13.2 mg/dL, hematocrit 37.3%, leucocites 32.420×103/uL (82% neutrophils). Abdominal ultrasound revealed spleen rupture with hemoperitoneum. She was submitted to total splenectomy, with identification of a volumous ruptured splenic cyst. Anatomopathological exam revealed a congenital cyst of stratified squamous epithelium. The patient had an uneventful recovery and was discharged home on postoperative day 5.

Comments Rupture as initial presentation of a congenital cyst is rare and mandates surgical therapy. Total splenectomy was the only option as the size of the cyst did not permit organ preservation.