Asian Journal of Case Reports in Surgery

Background: Non-parasitic splenic cysts are rare benign lesions that pose diagnostic and therapeutic challenges because of their varied etiology and clinical presentation. Recent advances in minimally invasive surgery, particularly single-incision gasless laparoscopy, have provided safer and cosmetically superior alternatives for spleen-preserving management. Splenic cysts possess an epithelial lining and often result from parasitic infection, whereas secondary splenic cysts (pseudocysts) lack an epithelial lining and typically arise secondary to trauma, infarction, or infection.

Aims: To describe the successful application of single-incision gasless laparoscopic fenestration for the management of a large non-parasitic splenic cyst in a young female patient, and to review the operative technique and clinical outcomes of this spleen-preserving minimally invasive approach.

Presentation of Case: A 19-year-old female presented with a two-month history of left upper abdominal discomfort. Imaging revealed an 8 × 8 cm cystic lesion at the superior pole of the spleen. Hydatid serology was negative, confirming a non-parasitic splenic cyst. Spleen-preserving laparoscopic fenestration via a single infraumbilical incision using a gasless technique was performed. Approximately 500 ml of serous fluid was aspirated and the anterior cyst wall was excised using a Ligasure device. The postoperative course was uneventful and the patient was discharged on the third postoperative day. Histopathology confirmed a splenic pseudocyst. At one-year follow-up, the patient was asymptomatic with no recurrence.

Discussion: Non-parasitic splenic pseudocysts are uncommon benign lesions increasingly managed with minimally invasive, spleen-preserving techniques. Single-incision gasless laparoscopic fenestration combines the cosmetic advantages of reduced port surgery with the physiological benefits of avoiding pneumoperitoneum-related hemodynamic and respiratory disturbances. This approach is particularly suited to superficially located cysts.

Conclusion: Single-incision gasless laparoscopic fenestration is a safe, effective, and cosmetically favorable approach for appropriately selected patients with non-parasitic splenic cysts. Careful patient selection, precise surgical technique, and diligent postoperative surveillance are essential to achieving optimal outcomes. This case report highlights significance of cosmetic minimally invasive spleen preserving approach for management of splenic cysts in a young female.