Quiste esplénico. Esplenectomía parcial con exclusión vascular laparoscópica / Splenic cyst. Laparoscopic partial splenectomy with vascular exclusion

RESUMEN Antecedentes: la esplenectomía conlleva peligro de infecciones de distinta naturaleza. El riesgo de sepsis fluctúa entre 4,25 y 18,2%. El tratamiento quirúrgico corriente en las afecciones del bazo es la esplenectomía; la resección parcial, cuando es posible, es la mejor opción. Objetivo: evaluar los resultados a partir de la resección parcial del bazo y oclusión vascular en porta dores de quistes esplénicos. Material y métodos: en un período de 3 años se realizó esplenectomía parcial en 4 pacientes con quiste esplénico, en dos de los cuales se empleó exclusión vascular. Femenino, 3; edad, 30,5 años; IMC, 26,1. Resultados: tiempo operatorio,120,75 minutos; de clampeo,12 minutos. Pérdida sanguínea sin clam peo, 700 y 200 mL; con clampeo, 50 y 30 mL. Un paciente fue reintervenido, completando la esplenec tomía por vía convencional. Tiempo de internación, 3,5 días. Conclusiones: la resección parcial del bazo con clampeo vascular transitorio es una opción factible y asegura, con escaso sangrado.

ABSTRACT Background: Background: Spleen resection is associated with high risk of infections. The risk of sepsis ranges between 4.25% and 18.2%. Splenectomy is the usual surgical practice in spleen diseases, and partial resection is the best option, when possible. Objective: The aim of this study was to evaluate the outcomes of partial splenectomy with vascular occlusion in patients with splenic cysts. Material and methods: Over a 3-year period, 4 patients with splenic cysts underwent partial splenec tomy; vascular exclusion was used in 2 of them. Three patients were women; age, 30.5 years; BMI: 36.1 Results: Operative time. 120.75 minute; clamping time, 12 minutes. Blood loss without vascular clam ping, 700 and 200 mL; with vascular clamp, 50 and 30 mL. One patient was reoperated with total splenectomy via the conventional approach. Length of hospital stay, 3.5 days. Conclusions: Partial splenectomy with temporary vascular clamping is a feasible and safe option with minor intraoperative bleeding.

Quiste epitelial esplénico gigante, características morfológicas y evolución postoperatoria: reporte de un caso / Epithelial splenic cyst. Morphological characteristics and postoperative evolution: case report

RESUMEN: Los quistes primarios del bazo (QPB), son lesiones poco frecuentes en patología quirúrgica; los mayores de 5 cm o sintomáticos deben ser tratados quirúrgicamente para evitar el riesgo de complicaciones. Se debe realizar un examen histopatológico para confirmar el subtipo de quiste esplénico y descartar una eventual transformación maligna del revestimiento epitelial pluripotencial. El objetivo de este manuscrito fue reportar un caso de QPB intervenido quirúrgicamente y revisar la evidencia existente respecto de sus características morfológicas, terapéuticas y pronósticas. Caso clínico: Se trata de una mujer de 18 años (MAC), que consultó por distensión abdominal progresiva, de varios meses de evolución. La tomografía abdominal reveló la existencia de una masa heterogénea de 21 cm de diámetro mayor, en relación con el colon transverso y la curva mayor gástrica. El examen intraoperatorio reveló una masa sólido-quística que surgía del mesocolon transverso. La cirugía consistió en la esplenectomía y exéresis en bloque del tumor. La paciente evolucionó de forma satisfactoria, dándose de alta al quinto día del postoperatorio. El diagnóstico de quiste epitelial esplénicose estableció en base al examen patológico de la pieza quirúrgica. Cursando su 6º mes postoperatorio sin inconvenientes. Se realizó control tomográfico, que permitió verificar un bazo supernumerario funcionante.

SUMMARY: Primary splenic cysts (PSC) are rare lesions in surgical pathology; those symptomatic, or greater than 5 cm, should be treated surgically to avoid the risk of complications. A histopathological examination should be performed to confirm the splenic cyst subtype and rule out a possible malignant transformation of the pluripotential epithelial lining. The aim of this manuscript was to report a case of PSC who had undergone surgery and to review the existing evidence regarding its morphological, therapeutic and prognostic characteristics. An 18- year-old woman (MAC), consulted for progressive abdominal distention of several months of evolution. Abdominal tomography revealed the existence of a large heterogeneous mass, 21 cm in diameter, in relation to the transverse colon and the greater gastric curve. Intraoperative examination revealed a solid cystic mass arising from the transverse mesocolon. Surgery consisted of splenectomy and in-block excision of the tumor. The patient evolved satisfactorily and was discharged on the fifth postoperative day. Diagnosis of epithelial splenic cyst was established based on the pathological examination of the surgical specimen. At six months postoperative the patient had evolved satisfactorily without complications. Following abdominal tomography control a functioning supernumerary spleen was confirmed.

Primary epithelial splenic cyst: A rare encounter

Splenic cysts are rare with an overall incidence of 0.07% in a large autopsy series and 0.5% among all the splenectomies done. The parasitic splenic cysts, usually caused by Echinococcus granulosus, account for 60% of all primary splenic cysts. The primary epithelial cysts account for 10% of all splenic cysts. We report a case of 30-year-old female presenting with left upper abdominal pain and heaviness. Computed tomography revealed a multiloculated cyst in spleen. Hydatid serology was negative. Total splenectomy was done. Histopathological evaluation was done and a diagnosis of primary epithelial splenic cyst was given.

Asymptomatic Splenic Cysts in an Immunocompromised Patient: Should They Be Investigated / 대한소화기학회지

Splenic abscess is a rare disease that generally occurs in immunocompromised patients. It is difficult to distinguish between splenic abscesses and cysts using imaging studies, especially if they are asymptomatic. A 50-year-old asymptomatic man who had received steroid therapy for underlying rheumatoid arthritis was referred to a university hospital due to presence of several splenic cysts, with the largest being 3.5 cm in diameter. Percutaneous aspiration was performed, and fluid analysis showed cysts infected by extended-spectrum, beta-lactamase-producing Escherichia coli. The patient was treated with ertapenem for four weeks, and the lesion disappeared on follow-up imaging studies. Splenic abscess should be included as a differential diagnosis of splenic cystic lesions in immunocompromised patients.

Quiste esplénico no parasitario: revisión de la experiencia en un hospital clínico universitario / Non parasitic splenic cysts: single-center experience at a university hospital

Introducción: Las lesiones quísticas esplénicas son poco frecuentes; pueden ser clasificadas en primarias y secundarias según la presencia de revestimiento epitelial. Los quistes parasitarios son provocados por especies de Equinococcus y su manejo es específico. Suelen ser lesiones asintomáticas y el tratamiento depende de su tamaño y de la aparición de manifestaciones clínicas. El abordaje quirúrgico tradicional ha sido la esplenectomía, pero con el reconocimiento de las complicaciones inmunológicas, han tenido auge las alternativas que conservan parénquima esplénico. Objetivo: Comunicar la experiencia en el manejo quirúrgico de esta enfermedad en nuestro centro. Resultados: Se presenta la serie de 11 casos de quistes esplénicos no parasitarios que recibieron tratamiento quirúrgico durante los últimos 15 años. La mayoría de las intervenciones fueron laparoscópicas y no se registró morbimortalidad. Discusión: En el tratamiento de los quistes del bazo no parasitarios actualmente se reconoce el valor de preservar parénquima y función esplénica. La esplenectomía, cirugía cuyo estándar actual es mediante laparoscopia, ha sido progresivamente desplazada por alternativas conservadoras. Las opciones terapéuticas dependen del desarrollo de síntomas, del tamaño y de la ubicación de las lesiones. Conclusiones: Los quistes esplénicos son poco frecuentes. Ante la necesidad de tratamiento quirúrgico el abordaje laparoscópico y las cirugías que conservan parénquima esplénico deberían ser de elección.

Introduction: Splenic cysts are rare. They have been classified in primary or secondary lesions based on the presence or absence of an epithelial lining. Parasitic cysts are caused by Echinococcus spp. and have a particular management. Splenic cysts are usually asymptomatic, treatment depends on the development of symptoms and diameter. Traditionally, splenectomy has been the standard surgery, but updated knowledge about the role of the spleen in preventing some infections has led to more conservative options. Objective: To report our experience in surgical management of the disease. Results: Our series includes 11 patients with non-parasitic splenic cysts treated surgically, during the last 15 years. Most were laparoscopic interventions and no morbidity or mortality was registered. Discussion: Surgical treatment for non-parasitic splenic cysts actually favours conservative techniques; salvage of the spleen whenever possible is fully justified based on updated knowledge of the role it plays in promoting protection against infection. Splenectomy, nowadays performed by laparoscopy, has been partially displaced. Treatment options depends on the cyst diameter, development of symptoms and localization. Conclusions: Splenic cysts are unfrequent. If surgical treatment is needed, laparoscopy and interventions conserving splenic parenchyma should be the election.

Quiste esplénico gigante en una adolescente: Caso clínico / Giant splenic cyst in a teenager girl: Case report

Los quistes esplénicos gigantes y no parasitarios son infrecuentes. Estas lesiones pueden manifestarse como dolor abdominal, si bien a menudo son asintomáticas y se diagnostican en forma incidental. Objetivo: Presentar el caso de un quiste esplénico epitelial gigante por su interés en la toma de decisiones diagnósticas y terapéuticas, al ser una entidad muy poco frecuente.
 Caso clínico: Paciente de sexo femenino de 13 años de edad que consultó por dolor abdominal de dos meses de evolución. En la exploración física se palpaba una masa de consistencia dura en hemiabdomen izquierdo. En los estudios de imágenes se visualizó una masa esplénica quística gigante. Se realizó esplenectomía obteniendo un quiste subcapsular que comprometía la mayor parte del bazo, el estudio anatomopatológico e inmunohistoquímico fueron compatible con quiste epitelial. La evolución postoperatoria y el posterior seguimiento ambulatorio fueron favorables. Conclusiones: El tratamiento de los quiste esplénicos gigantes no parasitarios es quirúrgico, intentando conservar, en lo posible, la mayor cantidad de tejido esplénico. Este procedimiento debe ser individualizado, considerando el tamaño, las posibilidades diagnósticas, el tejido esplénico residual, la edad del paciente y comorbilidades.

Giant nonparasitic splenic epidermoid cysts are relatively uncommon. These lesions can lead abdominal pain, but most of then are asymptomatic, and they are discovered incidentally. We report a 13-y old female with a giant splenic epidermoid cystic, given the special interest of diagnostic and therapeutic decision-making of this rare entity. Case report: A 13-y old female with clinical history of abdominal pain since the last two months. On physical examination a firm, tender mass was palpable in left hypochondrium. Diagnosis of a large cystic splenic mass was made based on ultrasound and abdominal computed tomography scan. Splenectomy was performed, and histopathological-immunohistochemistry studies revealed findings suggestive of primary epithelial cyst. The post-operative clinical course was satisfactory and uneventful. Conclusions: Treatment of giant nonparasitic splenic cysts is surgical. Preserve splenic parenchyma must be the aim in an individualized decision-making. The different types of surgical modalities will be according to the diagnosis and clinical situation (cyst size, age, comorbidities).

Extensive pelvic hydatid disease mimicking ovarian malignant tumour.

Hydatid disease is one of the commonest parasitic infections of the liver, endemic in many countries. Rupture into the peritoneal cavity leading to secondary echinococcosis is a difficult problem to manage. A case of 37 year old female patient presenting with disseminated intra-abdominal hydatid disease mimicking malignant multilocular cystic tumor of the ovary involving the mesentery of the small intestine, omentum and spleen is presented along with a brief review of literature.

Adenocarcinoma Arising from Heterotopic Pancreas in Association with a Splenic Cyst.

We report a rare case of adenocarcinoma arising from heterotopic pancreas in splenectomy specimen operated for a Splenic Cyst. This 40 year old female patient presented with vague upper abdominal pain and swelling. USG showed a large cyst within the spleen. The cyst along with the spleen is removed after laparotomy. The pancreas and other abdominal organs were unremarkable on ultrasonography and intraoperative examination. Gross examination showed a cyst with a smooth lining, entirely within the spleen. A small locule, communicating with the main cyst showed small papillary projections. On light microscopy, the cyst wall is lined by single layer of columnar cells. Section from papillary areas showed histological appearance of papillary adenocarcinoma. Remnant of normal pancreatic tissue was discovered at the wall of the cyst. We presume an origin from heterotopic pancreatic tissue in the spleen for this neoplasm and reporting the case for its rarity.

Never underestimate simple splenic cyst.

Although splenic involvement alone in hydatid disease is very rare, spleen is the third common organ involved in hydatid disease. It is endemic in cattle rearing areas but occurs worldwide. The rarity of splenic hydatid disease poses diagnostic challenge for clinicians. The case is presented as the investigation in the beginning which induced confusion among experienced clinicians but subsequently diagnosis of splenic hydatid cyst with peritoneal dissemination was confirmed by laparoscopy and histopathological examination. Hydatid disease of spleen should be considered in differential in every patient in endemic area with cystic lesion of spleen until proved otherwise as the hydatid cyst can present even as simple cyst without having classic serological and imaging features.

Splenic Cyst Mimicking Gastric Subepithelial Tumor Diagnosed by Endoscopic Ultrasonography

Recent research reveal that the diagnosis of gastric extraluminal compressions mimicking subepithelial tumor is increasing in numbers as esophagogastroduodenoscopy becomes widespread. Endoscopic ultrasonography is a very useful tool for differentiating extraluminal compressions from subepithelial tumors. Gastric extraluminal compressions are due to compression by either normal adjacent organs or pathologic conditions. Pathologic conditions are mainly benign, but some requires operation according to its size. We report a case of a 24-year-old female, who underwent esophagogastroduodenoscopy and was misdiagnosed with gastric subepithelial tumor. Endoscopic ultrasonographic findings showed anechoic cyst outside the gastric wall, which revealed to be a splenic cyst.

Enfermedad de hígado poliquístico asociado con quiste esplénico / Polycystic liver disease associated with splenic cyst

La enfermedad poliquística del hígado en el adulto es una condición infrecuente y benigna, autosómica dominante, asociada con frecuencia a enfermedad poliquística renal. Se caracteriza por la formación de quistes hepáticos numerosos, con o sin afectación renal. Algunos otros factores probablemente implicados en su génesis son la edad, sexo femenino, embarazo, y el uso de anticonceptivos orales. Las terapias quirúrgicas incluyen la aspiración percutánea del quiste con el escleroterapia, fenestración laparoscópica, fenestración laparotómica, la resección del hígado y el trasplante del hígado. Caso: Hombre de 50 años de edad con diagnóstico de hígado poliquístico asociado a un quiste esplénico diagnosticado por TAC abdominal y que se trató con una técnica de videoloparoscopia. Conclusión: La intervención quirúrgica para la enfermedad del hígado poliquístico sintomático se ha asociado a una morbilidad significativa. La fenestración videolaparoscópica de los quistes es un método seguro y extremadamente efectivo y se debe considerar como tratamiento inicial para la enfermedad del hígado poliquístico.

Polycystic liver in the adult is a rare and benign, autosomal dominant disorder, frequently associated with renal polycystic disease. It is distinguished by formation of numerous hepatic cysts, with or without renal involvement. Some other factors are also thought to be involved in its genesis, such as age, female gender, pregnancy, and the use of oral birth control pills. Surgical therapies include percutaneous cyst aspiration with sclerotherapy, laparoscopic fenestration, open fenestration, liver resection and fenestration and liver transplantation. Case: Polycystic liver disease associated with splenic cyst was diagnosed in a 50 years old man by abdominal computed tomography imaging and videolaparoscopic finding. Conclusion: Surgical intervention for symptomatic polycystic liver disease has been associated with significant morbidity. Laparoscopic cysts fenestration was safe and extremely effective and should be considered as initial treatment for polycystic liver disease.

Tratamiento del quiste esplénico mediante esplenectomía parcial laparoscópica: presentación de un caso / Treatment of splenic cyst by laparoscopic partial splenectomy: case report

Introducción: Los quistes esplénicos congénitos son raros. Son susceptibles a cursar con hemorragia, ruptura e infección, por lo que se deben resecar. El tratamiento mediante esplenectomía tiene la ventaja de no presentar recidiva pero conlleva el riesgo de complicaciones inmunológicas. El tratamiento mediante aspiración del quiste o decapsulación, aunque preserva el bazo tiene alta tasa de recidiva. La mejor opción es la esplenectomía parcial en la que se incluya una porción de tejido esplénico sano, lo que evita la recidiva y permite preservar el órgano. Caso clínico: Niña de siete años de edad con dolor abdominal y masa en hemiabdomen superior izquierdo. Por ultrasonido y tomografía axial computarizada se identificó quiste esplénico. Por laparoscopia, con bisturí armónico se efectuó esplenectomía parcial a 0.5 cm del margen del quiste. La paciente fue egresada al día siguiente sin complicaciones. Seguimiento con ultrasonido a un año, con preservación esplénica. Conclusiones: El abordaje laparoscópico permite la resección de los quistes esplénicos y extirpar la lesión con un margen de tejido sano sin riesgo de hemorragia y recidiva, con pronta recuperación del paciente, evitando la morbilidad asociada a las grandes incisiones.

BACKGROUND: Congenital splenic cysts are rare. They have a tendency to bleed, to become infected or to rupture and, for these reasons, must be treated. Treatment using splenectomy has the advantage of not presenting recurrence but carries the risk of immunological complications. Treatment through aspiration of the cyst or decapsulation preserves the spleen but with a high rate of recurrence. Optimal treatment is partial splenectomy. A portion of healthy splenic tissue is included that avoids recurrence and preserves the organ. We report the case of a child with a splenic cyst resolved by partial splenectomy done laparoscopically. CLINICAL CASE: We report the case of a 7-year-old female with abdominal pain and hemi-abdominal mass in the upper left abdomen. With the use of ultrasound and tomography, a splenic cyst was detected. With laparoscopy, a partial splenectomy was performed with harmonic scalpel at 0.5 cm from the outer cyst. The patient was released the next day without complications and was followed-up for 1 year. CONCLUSIONS: Laparoscopic approach allows resection of splenic cysts with a margin of healthy tissue without risk of bleeding or recurrence. Patient recovery is rapid, avoiding the morbidity associated with large incisions.

Diagnosis and management of splenic cysts / 国际外科学杂志

Splenic cyst is clinically rare.It can be classified as either true or false.Ultrasound,CT and MRI scan are helpful in diagnosing splenic cyst.Indication for a treatment depends mainly on clinical symptoms and diameter of the cyst.Now,there is a more conservative attitude on splenic surgery and the patient should be offered laparoscopic approach.Both nonoperatively treated patients and surgically treated patients should be given ultrasound examination regularly,in order to check the cyst size and exclude reappearance.

Spontaneous Rupture of a Primary Splenic Cyst Causing Hemoperitoneum

A 14-yr-old male presented with a hemoperitoneum caused by a spontaneous rupture of a primary splenic cyst. The laparotomy showed a ruptured spleen at the lower pole from one of the multiple cyst-like lesions, measuring approximately 2 cm in diameter. After the splenectomy, a microscopic examination confirmed the diagnosis of a primary splenic cyst lined with a mature, well-differentiated squamous epithelium. A hemoperitoneum caused by a spontaneous rupture of a primary splenic cyst is a rare but potentially lethal complication, because most patients with a splenic rupture present with some degree of hypovolemia.

Treatment of Splenic Cyst: Consideration of Laparoscopic Splenic Function Preserving Surgery through Our 5 Cases

PURPOSE: Concerns about patients experiencing overwhelming postsplenectomy sepsis have led to the development of splenic preservation procedures, and the advanced understanding of splenic vascular anatomy has permitted splenic preserving operations and conservative medical management. These are now accepted alternative procedure when dealing with pathologically benign splenic conditions and traumatic splenic injuries. The aim of the present paper was to evaluate the effectiveness and safety to this new spleen conserving procedure compare to open splenectomy. METHODS: From December 1999 through April 2004, five patients with splenic cysts who were treated by splenectomy and laparoscopic function preserving surgery (LFPS) were enrolled in this study. We analyzed the operation time, the amount of blood loss, the time to restart a regular diet, the hospital stay and the postoperative CT to retrospectively confirm the results of the operations. RESULTS: In four cases, the pathologic findings were splenic pseudocysts, and the other case was a cystic lymphangioma. The operative times were 138 minutes (range: 120~156 minutes) for LFPS and 130 minutes (range: 100~170 minutes) for total splenectomy. The amounts of blood loss were 20~30 cc for LFPS, and 20~800 cc for open splenectomy. For LFPS, the patients started their diet at postoperative day 1st and they were discharged at 4th (range: 3~5) day without complication. But for total splenectomy, normal diet was started at the 3rd day (range: 2~4) and they were discharged at the 11th day (range: 3~22) and one patient had complications. For LFPS, on the CT that was done 3 month after operation, we confirmed the complete excision of cysts without any operation related complication, there was no evidence of recurrence and the splenic parenchyme was preserved in a normal fashion in all cases. CONCLUSION: The success and relative ease of performing this laparoscopic function preserving procedure will pave the way for its future use in other selective cases involving splenic pathology.

Abordagem videolaparoscópica de cisto esplênico não parasitário / Laparoscopic approach of a nonparasitic splenic cyst

A rare case of primary splenic cyst is shown in a young woman who had a left subcostal abdominal pain. Abdominal echography and CT scan revealed a cyst of the anterior aspect of the spleen. A sorologic test for hidatic disease was negative. On the basis of a presumed diagnostic of nonparasitic cyst, the patient was referred to a laparoscopic decapsulation with excision of the cyst wall not covered by splenic tissue. The patient was discharged 24 hours later. Histological report revelead epidermoid cyst. The laparoscopic approach has being recently considered an effective and less invasive alternative in the treatment of splenic diseases. We demonstrated that it should be considered for the treatment of splenic cysts present in a superficial location, with the advantage of organ preservation.