Laparoscopic internal marsupializaton for large nonparasitic splenic cysts: effective organ-preserving technique

A splenic pseudocyst following laparoscopic sleeve gastrectomy: a case report

This is the first report of a patient presenting with a splenic pseudocyst following laparoscopic sleeve gastrectomy (LSG). A 26-year-old male with no chronic medical illnesses who underwent LSG presented with vague abdominal pain. An abdominal contrast-enhanced computed tomography revealed a 15 cm well-circumscribed cyst originating from the spleen. Intraoperatively, the findings were significant for a superficial cyst located at the lower pole of the spleen. A laparoscopic spleen-preserving procedure was conducted, specifically marsupialization and packing with omentum. The postoperative period was uneventful, and the patient was discharged on Day 2 postoperatively. The patient was free from complaints at outpatient follow-up clinics. Follow-up visits at the outpatient clinic were free from complaints. Pathology confirmed a splenic pseudocyst, and cytology was unremarkable. Since dissection during LSG is close to the spleen, infarction could occur, predisposing to pseudocyst formation. Marsupialization is an excellent surgical option when applied to appropriate splenic cyst types.

23-year old man with a long history of abdominal pain, nausea and vomiting: Case report of a splenic cyst

Introduction

Presentation of case

Discussion

Conclusion

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Large splenic cysts present with unspecific and upper GI-symptoms.

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Small splenic cysts are usually diagnosed incidentally.

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Large splenic cysts > 5 cm are recommended to be treated with a surgical procedure.

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Spleen-preserving procedures are preferred.

Large expanding splenic pseudocyst: A case report and review of literature

Introduction and importance

Splenic pseudocysts are extremely uncommon. Most of these cysts are asymptomatic and may result from previous blunt abdominal trauma. We report an interesting uncommon case of large splenic pseudocyst without history of previous abdominal trauma.

Case presentation

A 56 year old male patient, presented with symptoms of pain in the left side of middle back and discomfort in the left hypochondrium for few months. His physical examination was unremarkable. The abdominal Ultrasound and contrast-enhanced Computed tomography showed a large splenic cyst occupying most of the splenic parenchyma. Echinococcus multilocularis antibody test was negative. The differential diagnosis of this case included non-parasitic splenic cysts. The patient underwent elective exploratory laparoscopy which was converted to laparotomy with total splenectomy. Histopathological examination of the specimen revealed a splenic pseudocyst.

Clinical discussion

The splenic cyst in this case was symptomatic due to its large size. It was hard to elicit an etiology as there was no history of abdominal trauma, infection, or degenerative disease. The main factors in selecting either conservative or radical surgical approach for such cases are the cyst location, cyst size, and the residual splenic parenchyma.

Conclusion

The goal of splenic pseudocysts treatment is to relieve symptoms and avoid complications. Partial splenectomy is the recommended procedure when the size and location of the cyst allow preservation of at least 25% of splenic parenchyma. Otherwise, Total splenectomy is unavoidable.

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Splenic pseudocysts are extremely uncommon lesions of benign nature.

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Splenic pseudocysts are often secondary to the resorption of a hematomas due to previous blunt abdominal traumas.

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Sometimes it is hard to elicit a clear etiology of these cystic lesions.

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Cyst location, cyst size, and residual splenic parenchyma determine the therapeutic surgical approach.

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Partial splenectomy is the recommended procedure if at least 25% of splenic parenchyma is achievable.

Two cases of non-parasitic splenic cysts and spleen-preserving therapy

We review two different presentations of non-parasitic splenic cysts, both of which are post-traumatic in aetiology. The first case was of slower onset and was managed electively. The second case was of acute onset and was managed as an emergency. Non-parasitic splenic cysts are uncommon and the optimal management strategy for them is not well defined. Historically, treatment has been with open splenectomy; however, infection rates following this surgery have been high, making it an unattractive management option. Both cases were managed successfully with laparoscopic fenestration with no recurrence at subsequent follow-up.

A Rare Encounter with an Expanding Pseudocyst of the Spleen

Background

Splenic Pseudocyst (SP) is a diagnostic rarity, with cystic lesions of spleen themselves being uncommon. Establishing a preoperative diagnosis could help in specific management but this is rather challenging. Here we present a common presentation of an uncommon diagnosis.

Case Presentation

A 47-year-old lady, previously well, presented to the outpatient clinic with intermittent left hypochondrial pain radiating towards left shoulder for 2 months not associated with fever, jaundice, or weight loss. Abdominal examination revealed nontender hepatosplenomegaly. The initial abdominal ultrasonogram (USG) was suggestive of a hydatid cyst, for which she received a course of antihelminthics. At follow-up, after finding no clinical improvement and radiological worsening, she underwent an exploratory laparotomy. A cyst replacing entire lower pole and a significant portion of splenic hilum was found. Total splenectomy was performed. The specimen was reported to be a SP.

Conclusion

SP is a unique entity, usually misdiagnosed as a parasitic lesion and often treated with antihelminthic medicines. The natural course of disease, however, follows a subsequent failure of symptom resolution and radiological worsening that ultimately demands surgical attention. Based on size, location, and intraoperative findings, either total or partial splenectomy is required. The final histopathological report often presents a diagnostic surprise.

Oversized pseudocysts of the spleen: Report of two cases: Optimal management of oversized pseudocysts of the spleen

INTRODUCTION

Pseudocysts of the spleen are usually asymptomatic and associated with a history of trauma, infection or infarction. In this report, we present two uncommon cases of solitary, oversized pseudocysts of the spleen.

PRESENTATION OF CASE

Two patients (cases A and B), with symptoms of abdominal pain, were investigated. The laboratory and ultrasound examination confirmed the diagnosis of a large, non-parasitic splenic cyst in both cases. Computed tomography described an oversized pseudocyst occupying almost the entire splenic parenchyma in both cases and in patient A, the cyst was located in the splenic hilum. The medical history revealed a previous abdominal injury only in case A. The two patients underwent an open total splenectomy. The pathology examination verified the diagnosis of a non-parasitic splenic pseudocyst.

DISCUSSION

Both patients presented with symptoms, in contrast to the majority of patients with splenic cysts. The medical history of patients with splenic pseudocysts does not always reveal the cause of the pseudocyst formation. Any type of spleen-sparing procedure is not easy to perform in cases of surgical and anatomical difficulty, because of recurrence and the risk of intractable bleeding from the spleen.

CONCLUSION

Partial splenectomy is the recommended method for parenchymal preservation, but total splenectomy is preferred when the splenic cyst is oversized or cannot be excised with safety.

Laparoscopic management of giant splenic true cyst with partial splenectomy: a case report

Non-parasitic splenic cysts are relatively rare, and the optimal surgical treatment for them remains controversial. Laparoscopic unroofing is a relatively safe and easy technique, but a significant number of recurrences has been reported. Thus, complete cystectomy with partial splenectomy is recommended by several surgeons. However, patients sometimes suffer from intraoperative bleeding. Here, we report a patient with a giant non-parasitic splenic cyst who underwent subtotal cystectomy with partial splenectomy. After the dissection of the vessels circulating the upper pole at the splenic hilum, the resection line of the splenic parenchyma was on the ischemic side of the cyanotic demarcation line. A vessel sealing system and laparoscopic coagulation shears were used for the resection. We intentionally left about 10% of the cyst wall to avoid bleeding from the non-ischemic splenic parenchyma and remaining vessels. No recurrence has been detected after 6 months of observation. We believe this method could be a useful alternative procedure for the treatment of non-parasitic splenic cysts and preservation of the splenic parenchyma.

Partial Splenectomy for Splenic Cyst using a Bipolar Radiofrequency Device

The main goals of spleen preserving surgery are control of peroperative bleeding and maintaining the spleen's function postoperatively. Several techniques of spleen preserving surgery have been described. This report presents a new technique to perform partial splenectomy. We performed this partial splenectomy with a bipolar radiofrequency (RF) device in a 21 years old woman with a splenic cyst, with almost no peroperative blood loss.

Subtotal resection and omentoplasty of the epidermoid splenic cyst: a case report

Introduction

Nonparasitic splenic cysts are uncommon clinical entity and because of it, there is no information regarding their optimal surgical treatment.

Case presentation

A 41-years-old female with incidentally diagnosed nonparasitic splenic cyst which initially was asymptomatic. After two years of follow up, the patient underwent surgery; subtotal cystectomy and omentoplasty as an additional procedure. Postoperative course was uneventful.

Conclusion

Short and mid term results showed that near total cystectomy with omentoplasty was a safe successful procedure for treatment of epidermoid splenic cyst.

Giant true cyst of the spleen with elevated serum markers, carbohydrate antigen 19-9 and cancer antigen 125

A 19-year-old woman presented with a left upper abdominal mass. Computed tomography of the abdomen showed a solitary cystic lesion in the splenic hilum, approximately 20×16 cm in size, demonstrating almost total displacement of the remaining splenic parenchyma. She had high serum concentrations of carbohydrate antigen 19-9 and cancer antigen 125. A splenectomy was performed. Immunohistochemical study confirmed the existence of an epithelial cyst. Following surgery, the serum concentrations of the tumour markers decreased gradually. True splenic cysts are rare and their origin is controversial. In splenic cysts with high serum concentrations of tumour markers, such as occurred in our patient, cystectomy or splenectomy were preferred to remove tumour marker-producing epithelium and to prevent recurrence after treatment. If the epithelial lining of the cyst cannot be detected under light microscopy, immunohistochemical study should be performed.