Partial Splenectomy Research Articles

Spleen Salvaging Treatment Approaches in Non-parasitic Splenic Cysts in Childhood.

The aim of this study was to evaluate our experience with primary non-parasitic splenic cysts (NPSC) which are relatively rare in children and consist almost exclusively of single case reports or small case series in the literature. The medical records of all patients who presented to our clinic with NPSC between 2005 and 2015 were evaluated retrospectively. There were 22 children whose ages ranged from 2months to 14years (mean 9.2 ± 4.7years). The size of the cysts was in the range of 5 to 200mm (mean 55.4 ± 48.2mm). Ten patients underwent surgery for splenic cysts. Partial splenectomy (n = 2), total cyst excision (either open n = 4 or laparoscopically n = 1), and total splenectomy (n = 3) were performed. The non-operated patients were asymptomatic and followed with ultrasound (US). The follow-up period in non-operated patients ranged from 6months to 5years (mean 2.27 ± 1.29years). Complete regression was observed in four (33%) non-operated patients. The regressed cyst measurements were 10, 16, 30, and 40mm, respectively. Approximately half of the NPSC is diagnosed incidentally. Small (<5cm) asymptomatic cysts should be under regular follow-up with US/physical examination for regression. If surgery is required, we prefer open cyst excision as it gives excellent results and preserves splenic immune function.

Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases.

Splenectomy, while often necessary in otherwise healthy patients after major trauma, finds its primary indication for patients with underlying malignant or nonmalignant hematologic diseases. Indications of splenectomy for hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication splenectomy except nonmalignant hematologic diseases. However, splenectomy, even if with different modalities including laparoscopic splenectomy and partial splenectomy, continue to be a current surgical practice both in nonmalignant hematologic diseases, such as Immune Thrombocytopenic Purpura (ITP), Autoimmune Hemolytic Anemia (AIHA), Congenital Hemolytic Anemia such as Spherocytosis, Sickle Cell Anemia and Thalassemia and Malignant Hematological Disease, such as lymphoma. Today millions of people in the world are splenectomized. Splenectomy, independently of its cause, induces an early and late increase in the incidence of venous thromboembolism and infections. Infections remain the most dangerous complication of splenectomy. After splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with polysaccharide and conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria. At present, most of infections found in splenectomized patients are due to Gram-negative (G-) bacteria. The underlying disease is the most important factor in determining the frequency and severity of infections. So, splenectomy for malignant diseases has the major risk of infections.

Laparoscopic splenectomy for hereditary spherocytosis-preliminary report.

Splenectomy is considered standard surgical therapy in hereditary spherocytosis. The procedure is indicated in patients with severe anemia, recurrent hemolytic, and aplastic crises. The aim of the study was to assess treatment outcomes in patients with hereditary spherocytosis who underwent total or partial laparoscopic splenectomy. Fifteen patients aged 4-17 yr underwent laparoscopic splenectomy from 2009 to 2012. Partial and total splenectomies were performed (five and 10 children, respectively). Hematologic parameters, liver function tests, and splenic volume before and after the surgery were analyzed retrospectively. Total follow-up was 1-30 months. Hospitalization and operating time were similar in both groups. In partial splenectomy group, branches of splenic arteries gave better blood supply than short gastric vessels. In both groups, hematologic parameters were improved. Postoperative markedly elevated platelet count was maintained up to 6 months, and after that, platelet count gradually decreased to normal values. Bilirubin level was decreased in early postoperative period; however, it increased later to achieve levels lower than in preoperative period. No severe general infections were observed in both groups. Laboratory parameters (hemoglobin and bilirubin concentrations and RBC) after the surgery improved in all patients, and the effect was maintained during 12 months of follow-up. Platelet count increased significantly after the surgery and was maintained at high levels during the next 6 months. However, it returned to preoperative levels within a year after the surgery. Our study showed that partial splenectomy was not inferior to total splenectomy. However, full assessment requires longer follow-up and larger group of patients.

Spleen hydatidosis treated by hemi-splenectomy: A low-morbidity, cost-effective management by a recently improved surgical technique

BackgroundSplenic hydatidosis is a rare condition and is usually managed by total splenectomy, which is associated to various complications, including overwhelming post-splenectomy sepsis and thrombosis. Probably due to supposed technical difficulties, the partial splenectomy is rarely performed being often unknown to physicians, infectious disease specialists and surgeons. MethodsDemographic, clinical and surgical data were collected of four consecutive patients undergoing partial (or hemi-) splenectomy using an original, recently improved technique as a treatment for polar splenic hydatid cyst. The procedure implies a selective vascular ligation, a mechanical stapler-assisted section and haemostatic agents (Surgicel®) application on the cutting surface. Three patients were treated by laparotomy (including one affected by both liver and spleen localizations) whereas the last one was approached laparoscopically. ResultsPartial splenectomy operative time reached 74 min (range: 60–94 min) and blood loss was 8 ml (range: 5–10 ml). Hospital stay was 5.6 days (range: 5–7 days). At a mean follow-up of 20 months (range: 12–36 months), outcomes were uneventful. ConclusionsPartial splenectomy for hydatidosis is effective and safe. Physicians and surgeons should be aware of such an easy-to-catch option when dealing with benign splenic conditions, such as parasitic cysts. Cost-effectiveness, low morbidity and the possible prevention of splenectomy-related infectious complications should plead in favor of this technique in developing countries, where hydatidosis is endemic and post-splenectomy drugs and vaccines may be lacking.

Endometrial stromal sarcoma presenting as large bleeding left upper quadrant mass.

Endometrial stromal sarcoma (ESS) represents only 0.2% of all uterine malignancies. Even fewer cases have been reported on patients presenting with symptomatic disease. We report the case of young lady presenting with a large bleeding abdominal mass. At the time of surgery, an en bloc excision of the mass with a partial pancreatectomy, splenectomy, transverse colectomy, left nephrectomy, left adrenalectomy and resection of the diaphragm was performed. The final pathology revealed a malignant spindle and epithelial cell neoplasm with features favoring a variant of ESS. ESS can present in an atypical fashion as an intra-abdominal mass; a multi-disciplinary treatment approach for patients with this disease is crucial.

Laparoscopic partial splenectomy by using two techniques in goats

The aim of this study is to evaluate the laparoscopic partial splenectomy, using horizontal interrupted mattress suture and electro- cautery techniques in goats. Sixteenth adult goats were divided into two main equal groups (A and B). Each group was additionally divided into two equal subgroups, according to follow up on 15th and 30th days postoperatively for histopathology examination.All operations were performed under general anesthesia. Physical and clinical examination were measured pre-operatively and 1st to 7th days postoperative. The results revealed that the two techniques of both groups were performed successfully and the operation time in group A was 86.125±20 min., which was longer than that in group B 62.375±10 min. There were significant (P&lt;0.05) differences in the physical parameters in all the experimental goats. All animals gradually returned to the normal solid food intake and activity, defecation and urination after 72hrs postoperative. Laparoscopic gross pathological changes revealed adhesions between spleen, rumen, and abdominal wall which were more severe in group A as compared with group B. Histopathology examination showed that both groups were associated with collagen and fibrous tissue formation similar to capsule surrounding the site of the incision, which was more in group B than in group A, and the latter group was infiltrated with more inflammatory cells. Also group B had more lymphocyte aggregation around the central artery, in addition to that there was thickness of capsule and mature granulation tissue, but in group A there was edema, congested red pulp and immature granulation tissue.

Role of Laparoscopic Partial Splenectomy for Tumorous Lesions of the Spleen

BackgroundLaparoscopic partial splenectomy (LPS) is a surgical option for splenic masses, with the goal of reducing postoperative complications while preserving splenic function. MethodsThirty-seven patients who underwent laparoscopic splenectomy for tumorous lesions of the spleen at two affiliated hospitals were enrolled. Among them, 22 patients underwent laparoscopic total splenectomy (LTS) and 15 patients underwent LPS. ResultsThe tumorous lesions of the spleen in both groups, in order of decreasing frequency, consisted of epithelial cysts, hemangiomas, lymphangiomas, abscesses, metastatic tumors, and hamartomas. All procedures were completed by laparoscopy, and the pathologic lesions in the spleen were completely removed in both groups. There were no significant differences between the groups in terms of the operative time (LTS 151.5±98.5 min, LPS 168.6±46.8 min, p = 0.483), intraoperative blood loss (LTS 337.3±188.4 ml, LPS 422.6±187.4 ml, p = 0.185), and transfusion rate (LTS 3/22 [13.6 %], LPS 3/15 [20.0 %], p = 0.606). However, there were significant differences in postoperative complications such as pleural effusion (LTS 9/22 [40.9 %], LPS 0/15 [0 %], p = 0.005), splenic vein thrombosis (LTS 10/22 [45.5 %], LPS 0/15 [0 %], p = 0.002), and postoperative hospital stay (LTS 5.4±1.8 days, LPS 4.2±0.8 days, p = 0.027). ConclusionsLPS is a feasible, safe surgical procedure in patients with tumorous lesions of the spleen, and it represents an effective approach to reduce postoperative hospital stay and complications.

Partial splenectomy in sickle cell disease

Abstract Introduction Total splenectomy in sickle cell disease is related to a high risk of fulminant sepsis and increased incidence of other events, which have not been reported in patients with partial splenectomy. In this study we examined the patients with sickle cell disease and partial splenectomy and compared the clinical and laboratory results with non-splenectomised patients. Materials and methods We studied 54 patients with sickle cell disease who underwent partial splenectomy in childhood from 1986 until 2011 at the Institute of Hematology and Immunology. They were compared with 54 non-splenectomised patients selected by random sampling with similar characteristics. Results Partial splenectomy was performed at a mean age of 4.1 years, with a higher frequency in homozygous haemoglobin S (70.4%), and the most common cause was recurrent splenic sequestration crisis. The most common postoperative complications were fever of unknown origin (14.8%) and acute chest syndrome (11.1%). After splenectomy there was a significant increase in leukocytes, neutrophils, and platelets, the latter two parameters remained significantly elevated when compared with non-splenectomised patients. There was no difference in the incidence of clinical events, except hepatic sequestration, which was more common in splenectomised patients. Conclusion Partial splenectomy was a safe procedure in patients with sickle cell disease. There were no differences in the clinical picture in children splenectomised and non-splenectomised except the greater frequency of hepatic sequestration crisis in the first group.

Partial splenectomy in the era of minimally invasive surgery: the current laparoscopic and robotic experiences.

Partial splenectomy (PS) is a spleen-preserving technique that is applied as a result of trauma, focal lesions or hematological conditions. Despite the improvement of laparoscopic techniques within the past several decades, minimally invasive PS has remained a marginal technique that has not been well evaluated. Our objective was to provide an update on the indications and the feasibility of this procedure. The MEDLINE database (PubMed) was searched, and all relevant articles that involved a true minimally invasive PS (i.e., segmental or lobar devascularization of the spleen with parenchymal transection) were included. The search was conducted until the 31st of March 2014. Demographic data, operative indications, estimated blood losses, operative times, conversion rates and complications were extracted from the included articles and were summarized for discussion. Out of the 195 publications that were retrieved, 33 were included, which were mainly case reports and case series that represented a total of 187 patients. There were 37 men, 33 women and 117 patients of unknown gender. The mean age of the patients was ranged from 6 to 58 years. The mean total operative time was between 70 and 216 min for conventional laparoscopy and between 108 and 120 min for the robotic approach. For most studies, the mean estimated blood loss was minimal. The complication rate was 5.36% for conventional laparoscopy and 5.56% for the robotic approach. The outcomes of minimally invasive PS were favorable and comparable to those of the open technique according to the literature. This procedure may constitute an attractive alternative to the open technique for selected cases. Moreover, a robotic approach might be an interesting technical option, but additional research is needed before any definitive conclusions can be drawn.

Laproscopic partial splenectomy : A rare surgery for unusual diagnosis

Laproscopic partial splenectomy is a safe, minimally invasive technique for the treatment of solitary space occupying lesion (SOL) in splenic pole. Sclerosing angiomatoid nodular transformation (SANT) of the spleen is a rare benign vascular lesion, first described in the literature under this name in 2004. We report a case of upper pole splenic SOL diagnosed as SANT on HPE successfully managed by Laparoscopic partial splenectomy for the first time at INHS Asvini. The patient presented with pain left hypochondrium of 02 year duration. Ultrasonography (USG) and Contrast enhanced Computerized tomography (CECT) abdomen revealed a splenic mass in upper pole. The laproscopic partial splenectomy has proved to be both diagnostic and therapeutic.

Clinical significance of single-port laparoscopic splenectomy: comparison of single-port and multiport laparoscopic procedure.

PurposeSingle-port laparoscopic splenectomy has been performed sporadically. The aim of this study is to assess our experience with single-port laparoscopic splenectomy compared to conventional multiport laparoscopic surgery for the usual treatment modality for various kinds of splenic disease.MethodsBetween October 2008 to February 2014, 29 patients underwent single-port laparoscopic splenectomy and 32 patients received multiport laparoscopic splenectomy. We retrospectively analyzed the clinical outcomes of single-port group and multiport group.ResultsThe body mass index and disease profiles of the both groups were similar. The operative times of single-port and multiport group were 113.6 ± 39.9 and 95.9 ± 38.9 minutes, respectively (P = 0.946). The operative blood loss of the two groups were 295.8 ± 301.3 and 322.5 ± 254.5 mL (P = 0.582). Postoperative retrieved splenic weight of the single-port and multiport groups were 283.9 ± 300.7 and 362.3 ± 471.8 g, respectively (P = 0.261). One single-port partial splenectomy and 6 multiport partial splenectomies were performed in this study. There was one intraoperative gastric wall injury. It occurred in single-port group, which was successfully managed during the operation. Each case was converted to laparotomy in both groups due to bleeding. There was one mortality case in the multiport laparoscopic splenectomy group, which was not related to the splenectomy. Mean hospital stay of the single-port and multiport group was 5.8 ± 2.5 and 7.3 ± 5.2 days respectively (P = 0.140).ConclusionSingle-port laparoscopic splenectomy seems to be a feasible approach for various kinds of splenic disease compared to multiport laparoscopic surgery.

Robot-assisted and laparoscopic partial splenectomy for nonparasitic cysts

21 patients with nonparasitic spleen cysts were operated. Robot-assisted (RA) interventions were applied in 10 cases, laparoscopic--in 11 patients. Men surgery duration was 124 minutes in case of RA-technique and 120 minutes if laparoscopy was used. Blood loss was significantly lower in the group of RA resection (p=0.035). There were no conversions of access in the group of RA-operations while in group of laparoscopy conversion has been required in 1 case. We did not observe complications in case of RA-surgeries. Laparoscopic method was associated with 2 complications (left-sided hydrothorax and fluid accumulation in resection area). Postoperative hospital-stay did not differ in both groups and was 7.1 and 6.4 room-nights in case of RA-interventions and laparoscopy respectively. There were no deaths. Indications for robot-assisted partial splenectomy for nonparasitic cysts include location of mass in upper pole or hilus of spleen, its diameter more than 8 cm, body mass index more than 30 and splenomegaly. Lower pole resection and splenectomy are more advisable using laparoscopic method.

Study of diameter, length, tortuosity of splenic artery and its branches with its clinical implications

Background: Systematic knowledge of the splenic arterial vasculature would provide greater safeguards in the design of the surgical techniques but there are surprisingly few studies on the subject. For this reason, we studied morphological anatomy of splenic artery. Aims: To study morphological anatomy of splenic artery and clinical implications. The present study aims to report length, tortuosity, diameter of splenic artery and its branches. Material and Method: The measurements were taken on 50 donated embalmed cadavers irrespective of the sex in the Department of Anatomy, MGM Medical College, Navi Mumbai, Maharashtra. The findings were noted after dissection. The study was carried out between May 2009 to December 2012. Results: The mean length of splenic artery with tortuosity was 9.52 cm. The mean length of splenic artery without tortuosity was 12.76 cm. The splenic artery shows numerous tortuosities. The tortuosity decreases as the diameter increases. We found that superior polar branch was slender and thin can be easily damaged. To avoid this operation should start from inferior pole. The mean diameter of splenic artery was 5.144 mm that of superior ramus was 4.340 mm and inferior ramus was 3.760 mm. So we found weak inferior ramus supplying the lower pole of spleen. Due to which inferior pole was also supplied by additional branches. Conclusion: Knowledge of splenic artery has the clinical significance in planning and conducting procedures such as partial or total splenectomy, splenic aneurysm, splenic embolisation, splenography, surgical and radiological procedures of upper abdominal region to avoid any complications. Key words: splenic artery, length, diameter, tortuosity

Clinical outcomes of splenectomy in children: report of the splenectomy in congenital hemolytic anemia registry.

The outcomes of children with congenital hemolytic anemia (CHA) undergoing total splenectomy (TS) or partial splenectomy (PS) remain unclear. In this study, we collected data from 100 children with CHA who underwent TS or PS from 2005 to 2013 at 16 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a patient registry. We analyzed demographics and baseline clinical status, operative details, and outcomes at 4, 24, and 52 weeks after surgery. Results were summarized as hematologic outcomes, short-term adverse events (AEs) (≤30 days after surgery), and long-term AEs (31-365 days after surgery). For children with hereditary spherocytosis, after surgery there was an increase in hemoglobin (baseline 10.1 ± 1.8 g/dl, 52 week 12.8 ± 1.6 g/dl; mean ± SD), decrease in reticulocyte and bilirubin as well as control of symptoms. Children with sickle cell disease had control of clinical symptoms after surgery, but had no change in hematologic parameters. There was an 11% rate of short-term AEs and 11% rate of long-term AEs. As we accumulate more subjects and longer follow-up, use of a patient registry should enhance our capacity for clinical trials and engage all stakeholders in the decision-making process.

Hemangioendothelioma arising from the spleen: A case report and literature review.

Primary hemangioendotheliomas (HEs) of the spleen are rare, low-grade borderline-malignant vascular tumors. To date, only a few splenic HE cases have been reported in adults. In infants, one 9-year-old male patient has previously been reported, and the patient succumbed to the disease shortly following surgery. Currently, the clinical treatment and prognosis of the disease remains challenging to define, due to the extremely low number of cases reported. The current report presents the case of a 9-year-old pediatric patient with splenic HE, who survived with no recurrence or complications following a partial splenectomy. Additionally, a literature review was conducted to analyze the treatment and prognosis of the disease.

Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database.

Nearly half of all incidental splenectomies caused by iatrogenic splenic injury occur during colorectal surgery. This study evaluates factors associated with incidental splenic procedures during colorectal surgery and their impact on short-term outcomes using a nationwide database. Patients who underwent colorectal resections between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database according to Current Procedural Terminology codes. Patients were classified into two groups based on whether they underwent a concurrent incidental splenic procedure at the time of the colorectal procedure. All splenic procedures except a preoperatively intended splenectomy performed in conjunction with colon or rectal resections were considered as incidental. Perioperative and short-term (30 day) outcomes were compared between the groups. In total, 93633 patients who underwent colon and/or rectal resection were identified. Among these, 215 patients had incidental splenic procedures (153 open splenectomy, 17 laparoscopic splenectomy, 36 splenorraphy, and 9 partial splenectomy). Open colorectal resections were associated with a significantly increased likelihood of incidental splenic procedures (OR 6.58, p < 0.001) compared to laparoscopic surgery. Incidental splenic procedures were associated with increased length of total hospital stay (OR 1.25, p < 0.001), mechanical ventilation dependency (OR 1.62, p = 0.02), transfusion requirement (OR: 3.84, p < 0.001), re-operation requirement (OR 1.7, p = 0.005), and sepsis (OR: 2.03, p = 0.001). Short-term advantages of splenic salvage (splenorraphy or partial splenectomy) included shorter length of total hospital stay (p = 0.001) and decreased need for re-operation (p < 0.001). Incidental splenic procedures during colorectal resections are associated with worse short-term outcomes. Use of the laparoscopic technique decreases the need for incidental splenic procedures.

Robotic splenectomy: what is the real benefit?

The laparoscopic approach to a difficult splenectomy requires a longer total operative time and is frequently associated with an increased risk of bleeding and a high conversion rate. A total of 418 elective splenectomies were registered in the Department of General Surgery and Liver Transplantation of Fundeni Clinical Institute between January 1995 and June 2012, of which 299 splenectomies (212 laparoscopic and 77 robotic) were performed by a single surgical team and retrospectively documented. The effect of the learning curve and the relative complexity of each type of procedure were analyzed using the Minimally Invasive Splenectomy Score, which further allowed categorizing the splenectomies as simple or difficult. Statistical analyses using the CUSUM algorithm of the intra- and postoperative parameters of the laparoscopic and robotic approaches, for both the simple and the difficult splenectomies, were performed. The results of the statistical analyses clearly indicated that there was a learning curve effect for laparoscopic splenectomy but not for robotic splenectomy. When compared with the laparoscopic approach in difficult splenectomies, the robotic approach had a shorter total operative time (84.13 vs. 97.2 min), less blood loss (30.88 vs. 156.9 ml), and decreased risk of hemorrhagic complications during surgery. Laparoscopic splenectomy remains the approach of choice for simple splenectomies in the surgical treatment for common indications. The robotic system is particularly beneficial in difficult splenectomies (i.e., partial splenectomy, splenectomy in liver cirrhosis, splenic tumors, or malignant hemopathies).

Partial splenectomy for inşammatory pseudotumor of the spleen: a case report

Partial splenectomy for inşammatory pseudotumor of the spleen: a case report

English

Pediatric patient, operated case of enucleation of hydatid cyst of lung associated with splenic hydatid disease treated with partial splenectomy with preservation of splenic function is reported and the literature reviewed briefly.

Unusual Cause of Abdominal Pain

Question: A 24-year-old man visited our gastroenterology clinic due to intermittent, dull, left upper abdominal pain for 6 months. He had an unremarkable medical history and no history of abdominal trauma or surgery. He denied any weight loss. Physical examination revealed a palpable mass in the left upper abdomen. Laboratory examinations were within normal limits. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) were subsequently performed to clarify the nature of the lesion (Figures A and B). What are the findings of the abdominal CT and what is the diagnosis? Look on page 1609 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Abdominal CT revealed a large, cystic lesion of the spleen with partial calcification of the wall (Figure A, arrow). T2WI MRI revealed a 14-cm, homogeneous, hyperintense, cystic lesion without contrast enhancement. The patient underwent laparoscopic splenectomy for the symptomatic tumor (Figure C). On histologic examination, the splenic cyst was lined by mature squamous cells and walled by fibrotic tissues with inflammation (Figure D). A diagnosis of splenic epidermoid cyst was made. Cystic lesions of the spleen are uncommon.1Chen Y.Y. Shyr Y.M. Wang S.E. Epidermoid cyst of the spleen.J Gastrointest Surg. 2013; 17: 555-561Crossref PubMed Scopus (18) Google Scholar, 2Dan D. Bascombe N. Harnanan D. et al.Laparoscopic management of a massive splenic cyst.Asian J Surg. 2010; 33: 103-106Abstract Full Text PDF PubMed Scopus (20) Google Scholar, 3Fan H. Zhang D. Zhao X. et al.Laparoscopic partial splenectomy for large splenic epidermoid cyst.Chin Med J (Engl). 2011; 124: 1751-1753PubMed Google Scholar Acquired splenic cysts are caused by trauma, pancreatitis, parasite infection, or neoplasm. Congenital splenic and epidermoid cysts are rare, comprising <10% of all nonparasitic splenic cysts; only 78 cases were reported in a recent review from 1950 to 2012.1Chen Y.Y. Shyr Y.M. Wang S.E. Epidermoid cyst of the spleen.J Gastrointest Surg. 2013; 17: 555-561Crossref PubMed Scopus (18) Google Scholar Epidermoid cysts are lined by keratinizing and nonkeratinizing epithelium that may be squamous or cuboidal.1Chen Y.Y. Shyr Y.M. Wang S.E. Epidermoid cyst of the spleen.J Gastrointest Surg. 2013; 17: 555-561Crossref PubMed Scopus (18) Google Scholar The etiology is believed to be congenital and proposed as mesothelial inclusion with squamous metaplasia and fetal squamous epithelium in the cyst or metaplasia in the cells lining the splenic sinus. Patients with splenic epidermoid cysts usually present with cysts at a young age, with a median age of 19 years; there is a slight female predominance. The most common symptoms presented are left upper abdominal pain or a palpable mass. In patients with splenic epidermoid cysts, 90% are uniloculated and uncomplicated. Complications from cysts are uncommon, but can include infection (6.8%), rupture (9.8%), or bleeding (2.7%).1Chen Y.Y. Shyr Y.M. Wang S.E. Epidermoid cyst of the spleen.J Gastrointest Surg. 2013; 17: 555-561Crossref PubMed Scopus (18) Google Scholar On imaging studies, uncomplicated cysts are a solitary, well-defined cystic lesion, occasionally with plaque-like wall calcification. The treatment for symptomatic cysts is open or laparoscopic splenectomy.2Dan D. Bascombe N. Harnanan D. et al.Laparoscopic management of a massive splenic cyst.Asian J Surg. 2010; 33: 103-106Abstract Full Text PDF PubMed Scopus (20) Google Scholar, 3Fan H. Zhang D. Zhao X. et al.Laparoscopic partial splenectomy for large splenic epidermoid cyst.Chin Med J (Engl). 2011; 124: 1751-1753PubMed Google Scholar Conservative therapy, such as aspiration or sclerotherapy, is associated with a high recurrence rate and a risk of bleeding or infection; it is therefore not recommended.