Treatment of splenic cysts

Abstract

: Splenic cysts are a relatively rare entity with variable etiology. They are typically classified as primary or secondary cysts, and primary cysts are divided into parasitic and non-parasitic cysts. Parasitic cysts are typically caused by Echinococcus granulosis or multilocularis. Secondary cysts lack an epithelial lining and are therefore considered psuedocysts. They are frequently discovered incidentally and otherwise typically present with symptoms related to mass effect of the cyst. The management is greatly dependent upon size and symptomatology. Cysts that are parasitic, large, or symptomatic require operative intervention. Cysts that present with rupture or infection also require operative intervention. Laparoscopic surgery is safe and effective in surgical management of splenic cysts, and spleen preservation is preferable whenever it is possible, though splenectomy vaccines should be given if spleen preservation seems unlikely. There are a variety of techniques in operative management of splenic cysts. They can be managed by partial splenectomy, decapsulation, cyst fenestration, or unroofing of the cyst. The other technique that can be used in patients who are of prohibitive surgical risk is “PAIR” which stands for Puncture of cyst, Aspiration of cyst contents, Injection to sterilize the cyst, and Re-aspiration. This has a greater recurrence rate as does any technique that leaves any remaining cyst wall behind.