Severe Splenic Rupture After Minor Blunt Trauma in a Patient With an Epidermoid Splenic Cyst: A Case Report.

Splenic rupture following minor blunt abdominal trauma may occasionally be accompanied by unexpected perisplenic findings that complicate diagnosis and management. We report the case of an 18-year-old previously healthy male who presented with progressive abdominal pain 10 days after being struck in the left upper abdomen by a soccer ball during a recreational football match. Initial abdominal ultrasonography demonstrated extensive splenic injury and moderate hemoperitoneum but did not identify a focal infectious collection. Emergency diagnostic laparoscopy revealed an American Association for the Surgery of Trauma grade V splenic injury with active bleeding, dense inflammatory adhesions, and an unexpected encapsulated purulent-appearing perisplenic collection, requiring conversion to open splenectomy. Histopathological examination additionally demonstrated an 11-cm epidermoid splenic cyst with chronic subepithelial inflammation and no evidence of malignancy. The postoperative course was favorable, and the patient was discharged on postoperative day two with subsequent uneventful follow-up. The exact nature of the perisplenic collection and its temporal relationship to the traumatic event could not be definitively established. This case highlights the diagnostic complexity of severe splenic injury associated with an unexpected purulent-appearing perisplenic collection and an underlying epidermoid splenic cyst.