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Milickovic M, Rasic P, Cvejic S, Bozic D, Savic D, Mijovic T, Cvetinovic S, Djuricic SM. Splenic hamartomas in children. World J Clin Cases 2024; 12:1909-1917. [PMID: 38660549 PMCID: PMC11036520 DOI: 10.12998/wjcc.v12.i11.1909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
Splenic hamartomas (SHs) are uncommon, benign vascular lesions of unclear etiology and are mostly found incidentally on abdominal images, at surgery, or at autopsy. Since the first case description, in 1861, less than 50 pediatric SH cases have been reported in the literature. In this article, we have performed an analysis of all SH cases in children published in the literature to date and presented our case of an 8-year-old male with SH. These lesions in children were shown to cause symptoms more often than in the adult population. The observed SH sizes in children ranged from a few millimeters to 18 cm, and the symptomatic lesions were mostly larger or multiple. The most common clinical finding was splenomegaly. Signs of hypersplenism were present in children with a single SH larger than 4.5 cm (diameter range: 4.5-18.0 cm) and in those with multiple hamartomas, ranging from a few millimeters to 5 cm. Eighty percent of patients with available laboratory findings had hematological abnormalities such as anemia, thrombocytopenia, or pancytopenia. Other symptoms and signs included abdominal pain, recurrent infections, fever, night sweats, lethargy, growth retardation, and weight loss. The use of multiple imaging modalities may suggest the preoperative diagnosis of a splenic mass in children and determine the therapeutic approach. However, the final diagnosis of SH relies on histopathological evaluation. Surgery, including total or partial splenectomy (PS), is the mainstay of SH management. Although total splenectomy carries a greater risk of overwhelming post-splenectomy infection than PS it has remained the most performed surgical procedure in children with SH. In the majority of pediatric patients with symptomatic SH, resolution of symptoms and resolution or improvement of cytopenias occurred after surgical treatment.
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Affiliation(s)
- Maja Milickovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Petar Rasic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
| | - Sofija Cvejic
- Department of Radiology, The Children’s University Hospital, Belgrade 11000, Serbia
| | - Dejana Bozic
- Department of Clinical Pathology, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
| | - Djordje Savic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia
| | - Tanja Mijovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
| | - Sava Cvetinovic
- Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
| | - Slavisa M Djuricic
- Faculty of Medicine, University of Banja Luka, Banja Luka 78000, Bosnia and Herzegovina
- Department of Clinical Pathology, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Belgrade 11000, Serbia
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Babala J, Pini Prato A, Zahradnikova P, Beder I. Minimally Invasive Partial Spleen Resection Preserving the Lower Pole in Children: A Technical Report on Feasibility and Safety. J Laparoendosc Adv Surg Tech A 2021. [PMID: 34748423 DOI: 10.1089/lap.2021.0232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Laparoscopic partial splenectomy is a surgical option for removing part of the spleen with a pathological mass in a way that ensures preservation of the spleen's physiological functions. We aimed to evaluate the efficacy and feasibility of this procedure, performed while preserving the blood supply from the left gastroepiploic artery, in children. Materials and Methods: Following institutional review board approval, this retrospective study was conducted on patients who, between January 2015 and December 2019, underwent laparoscopic partial splenectomy with preservation of blood supply from the left gastroepiploic vessels. In the article, we described patient indications for surgery, surgical technique, surgery time, complications, and follow-up outcomes. Results: Eleven patients (mean age: 12.3 ± 3.4 years) underwent laparoscopic partial splenectomy. Indications for surgery included nonparasitic cysts (n = 8), pseudocysts (n = 2), and hamartomas (n = 1). The mean benign mass diameter was 60 ± 22 mm. The mean operative time was 193.2 ± 55.1 minutes. The mean size of the retained lower pole was 31.1% ± 3.8%. There was no conversion to open splenectomy or any significant complication. The mean postoperative stay was 9 ± 0.7 days. No thrombosis of the splenic and portal veins was noted in the follow-up period, and no splenic remnant infarction occurred. Conclusions: Laparoscopic partial splenectomy with preservation of blood supply arising from the left gastroepiploic vessels seems to be safe in children. However, a larger study is needed to confirm our results.
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Affiliation(s)
- Jozef Babala
- Department of Paediatric Surgery, Faculty of Medicine, National Institute of Children's Diseases, Comenius University, Bratislava, Slovakia
| | - Alessio Pini Prato
- Umberto Bosio Center for Digestive Diseases, The Children Hospital, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Petra Zahradnikova
- Department of Paediatric Surgery, Faculty of Medicine, National Institute of Children's Diseases, Comenius University, Bratislava, Slovakia
| | - Igor Beder
- Department of Paediatric Surgery, Faculty of Medicine, National Institute of Children's Diseases, Comenius University, Bratislava, Slovakia
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Cao XF, Yang LP, Fan SS, Wei Q, Lin XT, Zhang XY, Kong LQ. Incidentally discovered asymptomatic splenic hamartoma misdiagnosed as an aneurysm: A case report. World J Clin Cases 2021; 9:7231-7236. [PMID: 34540983 PMCID: PMC8409209 DOI: 10.12998/wjcc.v9.i24.7231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Splenic hamartoma (SH) is a rare, benign vascular proliferation that is often found incidentally. It may be misdiagnosed as a splenic aneurysm or splenic malignancy.
CASE SUMMARY A 21-year-old male patient was admitted to our hospital with a complaint of an incidentally discovered asymptomatic splenic space-occupying lesion for 2 wk. Abdominal computed tomography (CT) scan showed a circular low-density shadow in the hilum of the spleen. Contrast-enhanced CT revealed an aneurysm located in the hilum of the spleen before operation. Laparoscopic splenectomy was performed and postoperative pathology revealed the presence of SH.
CONCLUSION Imaging studies are insufficient for the differential diagnosis of SH from other diseases, and laparoscopic splenectomy is a less invasive procedure and useful for the diagnostic purpose as well.
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Affiliation(s)
- Xue-Feng Cao
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Li-Peng Yang
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Song-Song Fan
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Qiang Wei
- Department of Hepatobiliary Surgery and Clinical Nutrition Center, Binzhou Medical University Hospital, Binzhou 256600, Shandong Province, China
| | - Xu-Tao Lin
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Xing-Yuan Zhang
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
| | - Ling-Qun Kong
- Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou 256603, Shandong Province, China
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Romboli A, Annicchiarico A, Morini A, Castro Ruiz C, Pagliai L, Montali F, Costi R. Laparoscopic Partial Splenectomy: A Critical Appraisal of an Emerging Technique. A Review of the First 457 Published Cases. J Laparoendosc Adv Surg Tech A 2021; 31:1130-1142. [PMID: 33471586 DOI: 10.1089/lap.2020.0769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Laparoscopic partial splenectomy (LPS) may allow avoiding total splenectomy (TS) complications and maximizing the advantages of mini-invasive approach. The objective of this review is to assess feasibility and safety of LPS, to compare this approach with alternative options. Materials and Methods: A literature review of articles reporting LPS is performed. Several parameters, including age, indication, surgical technique, devices used for splenic section/hemostasis, adverse outcomes, including morbidity/mortality, conversions to open surgery, conversions to TS, operative time (OT), and hospital stay (HS), are analyzed. Articles comparing LPS' results with those of open partial splenectomy and laparoscopic TS are also analyzed. Results: Fifty-nine articles reporting 457 LPS were included. Patients' characteristics varied widely, concerning age and indications, including hematological disease (hereditary spherocytosis, drepanocytosis), splenic focal masses, and trauma. Several technical options are reported. Mean OT and HS are 128 ± 43.7 minutes and 4.9 ± 3.8 days, respectively. No mortality and 5.7% morbidity are reported. Conversion rates to open surgery and to TS are 3.9% and 3.7%, respectively. Conclusions: In conclusion LPS is feasible and safe, with no mortality, low morbidity, and low conversion rates to laparotomy and to TS. LPS may be accomplished by various techniques and tools. Major complications are sporadically reported, thus potential risks should not be underestimated.
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Affiliation(s)
- Andrea Romboli
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Alfredo Annicchiarico
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Andrea Morini
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Carolina Castro Ruiz
- Unità Operativa di Chirurgia Generale, Ospedale Civile di Guastalla, Guastalla, Italia
| | - Lorenzo Pagliai
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia
| | - Filippo Montali
- Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
| | - Renato Costi
- Unità di Scienze Chirurgiche, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italia.,Unità Operativa di Chirurgia Generale, Dipartimento Chirurgico, Ospedale di Vaio, Azienda Sanitaria Locale di Parma, Fidenza, Italia
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Li SC, Rangel AD, Kabeer MH. Precision Technique for Splenectomy Limits Mouse Stress Responses for Accurate and Realistic Measurements for Investigating Inflammation and Immunity. Bio Protoc 2019; 9:e3317. [PMID: 31497622 DOI: 10.21769/bioprotoc.3317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Splenectomy in an animal model requires a standardized technique utilizing best practice to avoid variability which can result in adverse impact to the animal resulting in flawed physiologic responses simply due to technique rather than to the studied variables. In the case of the spleen, often investigators are analyzing the animal immune or inflammatory responses. Surgical splenectomy involves many variables from the training and expertise of the surgeon, which directly correlates to surgical technique to the length of operation and ease of the procedure. This operation, in turn, impacts blood loss and insensible fluid losses, sterile technique, unintended trauma to the spleen and surrounding organs, the length of the incision and the duration of the operation with more prolonged exposure to anesthetic agents. All these variables ultimately play a significant role in the experiment since they directly affect the response of the model in terms of inflammation, immune activation, or even suppression. Undesired variables such as these go unnoticed and lead to inaccurate and misleading data.
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Affiliation(s)
- Shengwen Calvin Li
- CHOC Children's Research Institute, Neuro-oncology and Stem Cell Research Laboratory (NSCL), Center for Neuroscience Research (CNR), Children's Hospital of Orange County (CHOC), 1201 W. La Veta Ave.; Orange, CA 92868-3874, United States of America.,Department of Neurology, University of California-Irvine School of Medicine, 200 S Manchester Ave Ste 206, Orange, CA 92868, United States of America
| | - Anthony D Rangel
- CHOC Children's Research Institute, Neuro-oncology and Stem Cell Research Laboratory (NSCL), Center for Neuroscience Research (CNR), Children's Hospital of Orange County (CHOC), 1201 W. La Veta Ave.; Orange, CA 92868-3874, United States of America
| | - Mustafa H Kabeer
- Pediatric Surgery, Children's Hospital of Orange County, Orange, CA 92868-3874, United States of America.,Department of Surgery, University of California-Irvine School of Medicine, 333 City Blvd. West, Suite 1600, Orange, CA 92868, United States of America
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