Giant symptomatic splenic cyst treated with laparoscopic fenestration using single-incision plus one-port laparoscopic surgery: A case report.

Laparoscopic fenestration is the preferred treatment for symptomatic splenic cysts because it is curative and spleen-sparing. We report a case of a 25-year-old female who underwent laparoscopic fenestration for a giant splenic cyst using a single-incision plus one-port approach. She presented to our hospital with repeated vomiting. Imaging showed a 23 × 18 cm splenic cyst with no solid components, strongly compressing the stomach to the right side. Laparoscopic fenestration was initiated through a 2.5-cm umbilical incision, and a 5-mm port was added in the left abdomen intraoperatively. The drain placement was deemed necessary to prevent abscess formation and post-operative bleeding because of a thick cyst component and unexpectedly thick wall. Splenic cysts are typically benign and commonly develop in young people, hence, organ preservation and cosmetic results are crucial. Laparoscopic fenestration using single-incision plus one-port is considered to be an appropriate procedure for giant splenic cysts with non-serous contents.

A Giant Non-Traumatic Splenic Pseudocyst Successfully Treated With Cyst Aspiration and Partial Cystectomy: A Case Report and Review of Literature.

Splenic cysts are extremely rare entities that typically result from prior abdominal trauma, infections, and degenerative diseases. They are divided into two categories: true cysts with epithelial lining, and false pseudocysts without epithelial lining, which is more common than true cysts. We describe here a case of a non-traumatic splenic pseudocyst in a healthy 29-year-old male patient, who presented with left upper quadrant abdominal pain. Physical examination revealed scaphoid abdomen and left hypochondrium fullness. The spleen was uniformly enlarged, smooth, and firm, with mild tenderness. Laboratory testing was normal. An abdominal CT scan showed a huge unilocular non-enhancing cyst occupying the upper part of the spleen, measuring around 16 × 18.5 × 20 cm. The patient was managed with cyst aspiration and partial cystectomy. The histopathological examination findings are consistent with splenic pseudocyst. A one-year follow-up period revealed no complications or recurrence. Spleen cysts are rare in clinical practice, posing challenges in diagnosis and treatment. Surgical options include partial or total splenectomy, cyst aspiration, percutaneous drainage, partial cystectomy, and marsupialization. The choice depends on the cyst's size, splenic coverage, and relation to the hilum. Recently, spleen-preserving approaches have been favored to avoid life-threatening sepsis. Non-traumatic splenic pseudocysts present significant diagnostic dilemmas, requiring histopathological examination for definitive diagnosis. Spleen-preserving management is highly recommended to reduce the risk of life-threatening sepsis.

Isolated splenic lymphangioma in adulthood.

Isolated splenic lymphangiomas are rare benign lesions mostly seen in children are exceptionally rare in adults, often discovered incidentally due to their typically asymptomatic nature. This case report elaborates on the surgical excision of a rare splenic cystic lymphangioma in a 33-year-old woman, underscoring the diagnostic and therapeutic challenges these tumors pose. The patient's symptoms, abdominal pain and a palpable mass led to imaging through ultrasound and CT, which revealed a cystic splenic lesion. Total splenectomy was performed, revealing a large cystic mass, with pathological examination confirming a cystic lymphangioma. This case emphasizes the necessity of considering splenic lymphangiomas in adult patients presenting with splenic lesions. It also highlights the critical role of surgical interventions for definitive diagnosis and to prevent complications such as rupture and hemorrhage, thereby emphasizing on the complexity of managing rare splenic tumors.

Management of a large splenic hydatid cyst in pregnancy: A case report.

Splenic hydatid cysts are caused by the Echinococcus species and rarely occur in pregnancy. This case report describes the management of a 29-year-old pregnant woman with a large (11 × 8.7 × 10.5 cm) splenic hydatid cyst. The cyst had been identified before she became pregnant by her general practitioner with imaging investigations undertaken for her persistent left upper abdominal pain. The patient also had laboratory investigations which were positive for echinococcosis species. Hydatid splenic cysts are very rare and even more so in pregnancy. Risk of splenic cyst rupture exists, and rupture has significant risk of maternal and perinatal morbidity and mortality. Among the few case reports in the literature there is no clear consensus on conservative or surgical management during pregnancy and no clear guidelines for intrapartum care or delivery. The case report reviews the literature on splenic hydatid cyst disease in pregnancy and explores the management and outcome of this patient through her fourth pregnancy, which resulted in an uncomplicated vaginal birth.

Pre-extensively Drug-Resistant Pulmonary Tuberculosis With a Giant Primary Splenic Hydatid Cyst With Multiple Adverse Drug Reactions.

Drug-resistant tuberculosis is a noteworthy threat to public health, especially in high-burden countries. Management of these types of tuberculosis is lengthy and associated with a number of adverse drug reactions. Pre-extensively drug-resistant tuberculosis is a serious type of disease that is caused by the strains of Mycobacterium tuberculosis that are resistant to either rifampicin or both, i.e., rifampicin and isoniazid, and resistant to any fluoroquinolones. A splenic hydatid cyst is relatively rare and has never been reported in a case of pre-extensively drug-resistant pulmonary tuberculosis. The present case is a rare case of a young Indian male who was diagnosed with pre-extensively drug-resistant pulmonary tuberculosis through a cartridge-based nucleic acid amplification test and second-line drug susceptibility testing. Further, a diagnostic radiometric investigation showed a giant hydatid cyst in the spleen. He was started on an all-oral longer treatment regimen per the existing protocols. However, his treatment was associated with multiple adverse drug reactions.

Laparoscopic Resection of a Large Symptomatic Splenic Cyst: A Case Report.

Splenic cysts are a rare clinical finding, often discovered incidentally during imaging for unrelated conditions. These cysts can be congenital or acquired and may present with symptoms such as vague abdominal pain. This case report describes a 25-year-old female with no significant personal medical history but a family history indicative of a predisposition to lymphoma. She presented with epigastric pain, nausea, and anorexia. Upon examination, a palpable mass was detected in the left upper quadrant. Advanced diagnostic imaging, including computed tomography and magnetic resonance imaging, identified a large benign cystic lesion at the splenic hilum. The patient underwent laparoscopic removal of the cyst, and histopathology confirmed it to be a benign epithelial splenic cyst. The patient experienced an unremarkable postoperative recovery and significant relief from symptoms. This case highlights the importance of advanced imaging in accurately identifying and managing splenic cysts and demonstrates the effectiveness of minimally invasive surgery for such conditions.

Primary isolated hydatid cyst of the spleen: A case report.

INTRODUCTION AND IMPORTANCE: Primary (isolated) splenic hydatid cyst is rare and accounts for less than 2 % of hydatid patients, even in endemic regions. Diagnosis of splenic hydatid cyst can be challenging due to the rarity of the condition and its nonspecific symptoms. Surgery is the mainstay of treatment. This case report discusses management options for such a rare condition. CASE PRESENTATION: We present a 33-year-old female patient with abdominal pain for six months and splenomegaly. Ultrasonography and CT scan showed a giant splenic cyst with clear walls and multi-vesicular contents suggestive of a hydatid cyst. There was no involvement of the liver or other organs. Indirect hemagglutination was positive for Echinococcus. Through a left subcostal incision total splenectomy was performed. The patient was discharged from hospital on the sixth postoperative day. No local recurrence was detected during postoperative follow up. CASE DISCUSSION: Primary splenic hydatid disease is rare. It may be detected incidentally or present with nonspecific complaints. If untreated, a splenic hydatid cyst can lead to various potentially severe complications, including cyst rupture and secondary infection. Standard treatment is open total or partial splenectomy: preservation surgery should always be considered, to avoid post splenectomy infection, especially in young patients. CONCLUSION: Primary splenic hydatid cyst is rare even in endemic areas. Symptoms may be non-specific. Standard treatment is open total or partial splenectomy.

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.

Giant non-parasitic splenic cyst: a case report.

BACKGROUND: Splenic cysts are quite rare and asymptomatic. They may result from infection by a parasite, especially Echinococcus granulosus (hydatid cyst), or from non-parasitic causes. Since primary splenic cysts are not common, simple cysts can be misdiagnosed with a hydatid cyst in endemic areas. CASE PRESENTATION: We reported a 14-year-old Iranian girl initially presented with a vague abdominal pain, which progressed to left shoulder pain, fullness, early satiety, and shortness of breath and remained undiagnosed for 7 months despite seeking medical attention. Finally, imaging revealed a massive splenic cyst measuring 220 mm × 150 mm × 160 mm raising concern for a hydatid cyst due to regional endemicity. Consequently, the patient underwent total splenectomy. However, histopathological examination surprisingly revealed a simple non-parasitic cyst. CONCLUSIONS: Detecting rare simple spleen cysts requires early ultrasonography (US) and careful reassessment of diagnoses for non-responsive or worsening symptoms. Distinguishing them from splenic hydatidosis, especially in endemic areas, demands thorough paraclinical evaluations and patient history regarding potential parasitic exposure. While total splenectomy is the primary treatment for these huge cysts, the optimal surgical approach should be tailored case by case. These insights emphasize a comprehensive diagnostic approach to enhance accuracy and optimize patient care for these uncommon cysts.

Watchful Waiting Phase As Window of Opportunities for Non-pharmaceutical and Non-surgical Management of a Small Splenic Cyst Complicated With Thrombocytopenia.

An asymptomatic splenic cyst smaller than 50 mm was detected incidentally at a routine health checkup. Management of the cyst, affected and determined by multiple factors, including force majeure, became difficult and thrombocytopenia developed during watchful waiting. Spontaneous recovery of the spleen did not occur with continued watchful waiting, and thrombocytopenia worsened. However, when a three-month dietary intervention was subsequently implemented, the initiation of recovery was observed. The diet modification was adding to regular meals a daily serving of vegetables prepared following traditional Chinese culinary style. A second course of dietary intervention was undertaken, and accelerated recovery was detected thereafter, with eventual complete resolution of the splenic cyst and thrombocytopenia. This case demonstrates the feasibility and potential benefits of lifestyle intervention for the management of small splenic cysts, including those complicated with thrombocytopenia. Lifestyle intervention, such as dietary intervention, is particularly suitable for the watchful waiting phase since disease management during this time is non-pharmaceutical and non-surgical by nature.

[Laparoscopic partial resection of spleen in a 15-year-old girl]. / Laparoskopicheskaya partsial'naya rezektsiya selezenki u devochki 15 let.

Non-parasitic splenic cysts account for 0.5-10% of diseases of this organ. Incidence of splenic cysts has increased in recent years that may be associated with widespread use of abdominal imaging. Symptoms are absent in most cases. Splenic cysts > 5 cm are prone to complications such as bleeding, rupture or infection. These patients require surgical treatment. The authors present multilocular splenic cyst in a 15-year-old patient. The girl was followed-up for 2 previous years due to asymptomatic small cyst. However, cyst enlargement required surgical treatment. Examination revealed multilocular cyst 7×10 cm in the upper pole of the spleen. Enzyme immunoassay did not reveal antibodies to echinococcus. Laparoscopic partial resection of spleen was performed. This case is an example of modern surgical approach for nonparasitic splenic cysts characterized by minimally invasive organ-sparing technologies.

An Isolated Splenic Hydatid Cyst.

An isolated hydatid cyst of the spleen is a rare presentation of echinococcal diseases, especially in non-endemic areas where it may end up with unnecessary work-up and misdiagnosis. Here, we present the case of a 28-year-old female presenting with generalized abdominal pain, constipation, and early satiety who had a delayed diagnosis of isolated splenic hydatid cyst which was partially treated with albendazole, eventually requiring splenectomy.

Robotic-assisted excision of splenic epidermoid cyst in an adolescent patient in a new robotic platform: A case report.

Laparoscopic management of non-parasitic cysts (NSCs) of the spleen is currently the standard of care. There is a paucity of data of robotic management of NSCs. Here, we report a case of a NSC in a 13-year-old male. The patient presented to us with the chief complaints of pain in abdomen and feeling of a left upper abdomen lump for the last 3 months. The spleen being an important organ for immunity, we decided to opt for splenic preservation. Since minimal access methods offer the best outcome and we wanted to go with a safe option, we settled for near-total cystectomy of the splenic cyst. Here, we review the literature regarding the surgical management of NSCs and discuss the robotic technique for the accomplishment of the surgery.

Differential Diagnosis of Cystic Lesions of the Spleen: A Review of Clinical, Imaging and Pathological Findings.

Cystic lesions of the spleen are being noticed with increased frequency as "incidentalomas" during imaging work-up for unrelated causes. As a group, these lesions encompass pure cystic and mixed cystic and solid, benign and malignant processes that in general require a tissue sample for definitive diagnosis. In this review, we will describe the differential diagnosis of cystic lesions of the spleen, highlighting key imaging, clinical and pathologic findings.

A case of giant primary splenic hydatid cyst: Case report.

Introduction: Primary splenic hydatidosis is a rare zoonotic disease, common in grazing regions of the world. Primary splenic hydatid cyst is rare and accounts for <2% of patients. Splenectomy is advocated in case of giant hydatid cyst locating in central and hilum area; however, spleen salvaging operations are done in superficial cyst, cysts localized to one pole of the spleen or cysts that are unresectable due to extensive adhesions and in children. Presentation of case: We present a case of 29-year male patient from rural areas presented with the complain of left hypochondriac pain and tenderness along with the history of farming and cattle raising. There was no other significant history. Clinical findings and investigations: Physical examination showed mildly distended abdomen, mild tenderness over left hypochondrium. Routine laboratory investigations were sent. Ultrasound and CT scan of the abdomen showed giant splenic cyst measuring approx. 15 × 14 × 11 cm along with daughter cysts. Postoperatively, cyst was sent for histopathological examination. Intervention and outcome: Preoperatively, vaccinations against Pneumococcus, Hemophilus influenzae and Meningococcus along with Albendazole (15 mg/kg/day) was given 2 weeks before the planned operation. Total splenectomy was performed and diagnosis was confirmed by histopathological examination. Albendazole was continued for 2 more weeks. Patient remains asymptomatic thereafter and regularly followed up in OPD basis. Relevance and impact: Presence of isolated splenic cyst should raise suspicion for primary splenic hydatid cyst in endemic areas. Splenectomy versus spleen salvaging options should be analyzed and performed as per the indications. Splenic hydatid cyst is one of the rare clinical findings and there is very much high chance that it goes undiagnosed during the clinical practice. So, the main motive behind writing this article is to shed knowledge on basic approach to this splenic finding.

Laparoscopic organ-sparing surgery for cystic lesions of the spleen - own observations.

<b>Introduction:</b> Splenic cysts are quite rare. In this publication, authors focus on presenting their own observations related to the management of patients with such lesions. </br></br> <b> Aim:</b> To evaluate the effectiveness of laparoscopic procedures in the case of patients with splenic cysts. </br></br> <b>Material and methods:</b> The study included patients treated surgically for cystic lesions located in the spleen at the 2^nd Department of General, Gastroenterological and Oncological Surgery of the Medical University of Bialystok over the years 2017-01.2020. </br></br> <b>Results:</b> All patients were referred for elective excision of the spleen lesion (the size of the lesions ranged from 7 to 15 cm - based on CT examination). In all cases, excision of the anterior wall of the cyst was performed with the help of advanced surgical tools. The duration of the procedure ranged between 65 and 100 minutes. No significant blood loss was observed. No postoperative complications were found. </br></br> <b>Conclusions:</b> In conclusion, sparing laparoscopic surgery for cystic lesions of the spleen seem to be safe and rarely associated with complications or relapses. Extending the scope of the procedure to total splenectomy should also not pose a major problem.

The Usual Presentation of an Unusual Case: Spontaneous Primary Splenic Cyst Rupture.

Acute abdominal pain is one of the most common reasons for emergency admissions. Even though initial differentials are wide, a physician is able to narrow them down with detailed history, careful physical examination, and appropriate laboratory tests along with imaging studies. Unfortunately, some of the cases do not have an established diagnosis despite multiple blood work and imaging studies in the emergency department. In such conditions, physicians' recognition of rare diseases generally avoids extra costs for additional investigations, unnecessary consultations, and most importantly wasting valuable time in life-threatening conditions in emergency settings. Here, we report a 30-year-old woman with acute severe abdominal pain and hemodynamic instability who was found to have ascites that was actually hemoperitoneum secondary to spontaneous primary non-parasitic splenic cyst rupture. The primary splenic cyst is an extremely rare entity and is often found on imaging incidentally. A few case reports regarding primary splenic cyst and its complications were published in the literature. Since it is an exceptionally uncommon condition, there is no consensus on treatment. We aimed to increase the understanding of spontaneous primary splenic cyst rupture and its management among healthcare providers with this case report.

Giant splenic cyst complicated by infection due to Salmonella enterica serovar Livingstone in a previously healthy adolescent male: a case report.

BACKGROUND: Splenic cyst complicated by non-typhoid Salmonella infection is rare in healthy individuals in the era of antibiotics. Salmonella enterica subsp. enterica serovar Livingstone causing infection of giant splenic cyst has not been previously reported. CASE PRESENTATION: We report a case of giant splenic cyst (maximum diameter, 21 cm) complicated with Salmonella Livingstone infection, which resulted in splenic abscess, in a 16-year-old previously healthy adolescent male. The splenic abscess was successfully treated with ultrasonography-guided percutaneous drainage and antimicrobial therapy. CONCLUSION: Infection of splenic cyst may be caused by S. Livingstone in immunocompetent individuals. This case may help clinicians to raise awareness towards splenic abscess and highlights the importance of drainage and antimicrobial agents to avoid splenectomy.

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

INTRODUCTION: Splenic cysts are rare. They are usually incidentally diagnosed and there is no harmonised treatment pathway. We report a case of a large splenic epidermoid type cyst without history of previous abdominal trauma. PRESENTATION OF CASE: A 23-year old male patient presented with symptoms of upper abdominal pain, nausea and vomiting. Except for a tenderness in the upper and lower left quadrant of the abdomen, the initial examination showed no extraordinary findings. A contrast enhanced computed tomography revealed a large singular splenic cyst displacing neighbouring structures. Echinococcus serology was tested negative. A laparoscopic fenestration of the superficially located splenic cyst was performed. Perioperative course was free of complications. Histopathological analysis of the excisate showed a squamous lining indicating the cyst as epidermoid type. DISCUSSION: Non-parasitic cyst types include traumatic, neoplastic, degenerative and congenital cysts. Due to its considerable size, our patients splenic cyst was diagnosed after occurring symptoms lead to further examination (CT scan). Laparoscopic fenestration of the cyst was chosen as the optimal surgical approach because of the superficial location of the cyst and to preserve residual splenic parenchyma. In the present case, recurrence of the splenic cyst appeared, which left the patient with a total splenectomy as the final treatment choice. CONCLUSION: Due to the unspecific symptoms, the diagnosis of a splenic cyst can be prolonged. Choosing the adequate surgical technique to avoid complications is crucial. By deepening the understanding of the condition and surgical approaches, we can improve diagnostic and therapeutic management for affected patients.

Laparoscopic dome resection for pediatric nonparasitic huge splenic cyst safely performed using indocyanine green fluorescence and percutaneous needle grasper.

INTRODUCTION: In recent years, dome resection, which preserves the splenic immunological function, has been the primary technique used to treat splenic cysts. We herein report a surgical technique using a needle grasper and indocyanine green (ICG) fluorescence to perform dome resection of a huge nonparasitic splenic cyst in a pediatric patient. PATIENT AND SURGICAL TECHNIQUE: A 13-year-old girl was incidentally diagnosed with a splenic cyst during follow-up for scoliosis. Abdominal enhanced computed tomography (CT) showed a 17 × 14 × 14 cm unifocal cyst. Laparoscopic dome resection was planned. The intraoperative findings showed that the spleen was distended, but there was no apparent prominence of the thin cyst wall on the surface of the spleen. An ICG fluorescence camera overlay revealed poor coloration in the thinning area. We punctured the area and aspirated the cyst contents. We grasped the cyst wall with a percutaneous needle grasper and dissected the cyst wall with a vessel sealing system. We placed anti-adhesion agent at the dissection line to prevent recurrence. DISCUSSION: ICG fluorescence was useful for identifying the thinning area of a splenic cyst. The use of a percutaneous needle grasper facilitated the performance of dome resection of a huge splenic cyst in a pediatric patient with minimal invasiveness and an improved cosmetic outcome.