Introduction and importance: Splenic epidermoid cysts (SECs) are exceedingly rare, accounting for less than 1% of all splenic cysts. They are often asymptomatic and incidentally detected. Diagnostic and therapeutic challenges increase in low-resource settings due to limited access to imaging and timely care. Case presentation: A 25-year-old multiparous woman from rural Somalia presented with worsening abdominal pain and a palpable mass, exacerbated by successive pregnancies. Symptoms began three years earlier after blunt abdominal trauma. Due to diagnostic delays, the lesion progressed significantly. Imaging revealed a large cystic mass (11.3 × 13.6 × 11.4 cm) at the spleen’s lower pole. Open total splenectomy was performed. Histopathology confirmed an epidermoid cyst lined with stratified squamous epithelium. Recovery was uneventful, and follow-up showed full resolution. Clinical discussion: This case illustrates the clinical and surgical challenges of managing SEC in resource-limited environments. Differential diagnosis with hydatid cysts is essential. Although laparoscopic techniques are preferred in high-resource settings, open splenectomy remains a practical and effective approach where such technology is unavailable. Conclusion: SECs pose unique challenges in underserved settings. This case emphasizes the importance of timely diagnosis and adaptable surgical approaches in low-resource healthcare systems
Omar et al. (Fri,) studied this question.