Laparoscopic Approach to Primary Splenic Cyst: Case Report and Review of the Literature

Splenic cysts are rare benign lesions of the spleen, often asymptomatic and incidentally discovered during imaging studies. While many splenic cysts remain asymptomatic and do not require intervention, surgical management becomes essential in cases of symptomatic cysts, large cysts, or when malignancy cannot be ruled out. Laparoscopic surgery has emerged as a minimally invasive and effective approach for treating splenic cysts, offering advantages such as shorter hospital stays, reduced postoperative pain, and faster recovery. In this case report, we describe our experience with laparoscopic surgery for a symptomatic splenic cyst in a young patient.

Unraveling a rare splenic pathology: a case report of a benign hemorrhagic spleen with primary congenital splenic epidermoid cysts

Introduction and importance

A primary congenital splenic epidermoid cyst is an immensely rare pathology with mostly unknown epidemiological parameters. Misdiagnosis can easily happen and this results in life-threatening ramifications for patients. Considering this pathology as a potential differential diagnosis allows for the required surgical intervention to be timely accomplished. In this case, the authors are documenting this pathology and presenting how it was successfully managed via proper and informed preoperative analysis and meticulous intraoperative technique.

Case presentation

Hereby, we portray the exceptionally rare case of a 7-year-old male who presented to our surgical clinic complaining of a sudden left hypochondriac pain with early satiety for 1 month's duration. The preoperative radiological assessment displayed numerous splenic cystic lesions throughout the splenic parenchyma.

Clinical discussion

Resection of the cysts was accomplished via total splenectomy. The ensuing histopathological analysis via Hematoxylin and Eosin of the resected specimens established the diagnosis of a congested hemorrhagic spleen with multiple primary congenital splenic epidermoid cysts.

Conclusion

Primary congenital splenic epidermoid cysts are an extremely rare type of splenic pathology. There is profound scarcity amidst the published literature regarding it. This merits in-depth study and apt documentation to raise awareness regarding this pathology as a potential differential diagnosis in cases of abdominal pain. Documentation allows us to set up proper and innovative clinical and surgical protocols for these patients. Based on our conclusive review of the published literature, the authors conclude that ours is the first ever documented case from our country of a primary congenital splenic epidermoid cyst.

A splenic 'cyst': histology confirmed splenic sarcoma

Primary malignant fibrous histiocytoma, now classified as pleomorphic undifferentiated sarcoma, is the most common soft-tissue sarcoma in adult life. Primary splenic pleomorphic undifferentiated sarcoma is extremely rare and aggressive, and is associated with a poor prognosis; only 14 cases of splenic pleomorphic undifferentiated sarcoma have been documented in the English literature. We discuss a case of a 56-year-old woman with iron-deficiency anaemia, early satiety and left upper-quadrant pain, who was preoperatively diagnosed with a large splenic cyst following thorough investigation. This was excised in an elective procedure. Unfortunately, histology confirmed splenic pleomorphic undifferentiated sarcoma. Following a review and summary of the literature, we discuss key differentials between splenic cysts and splenic pleomorphic undifferentiated sarcoma. This case highlights that iron-deficiency anaemia is unusual in splenic cysts and more sinister causes must be considered.

A novel therapeutic approach to non‐parasitic splenic cysts: Laparoscopic fenestration and endothelium obliteration

Splenic cyst is a relatively rare disease; true splenic cysts are classified as parasitic and non-parasitic cysts. Although most cysts are asymptomatic, large cyst cases show clinical symptoms, consisting mainly of dyspepsia and fullness in the upper left abdomen. Surgical intervention is recommended primarily for large cysts to prevent complications such as rupture, hemorrhage, and infection. This paper presents our experience of eleven laparoscopic procedures for non-parasitic splenic cysts. Laparoscopic fenestration was performed in all cases, and the cyst endothelium was destroyed . All operations were accomplished successfully. The mean operative time was 56 minutes (range 40-90 minutes). Intraoperative bleeding was 15 ml (range 5-30 ml), oral food intake was started on the first postoperative day. The median duration of postoperative hospitalization was 2.8 days (range 1-7 days). There were no postoperative complications. All cases were followed up for a period of 21 months to 5.5 years, and no recurrence occurred. Laparoscopic fenestration and endothelium obliteration is an advantageous approach to large non-parasitic splenic cysts with little postoperative pain, fast recovery, splenic tissue and splenism preservation, low complication rates, and a short hospital stay; it is easily accepted by patients. It yields favorable medium-term results. Our study confirms that good results can be achieved with an approach of laparoscopic fenestration and endothelium obliteration for simple non-parasitic splenic cysts.