Treatment Of Splenic Cysts Research Articles

Результати хірургічної корекції або консервативного ведення кіст селезінки в дітей за даними віддалених моніторингових змін

Treatment of splenic cysts (SC) in children is variable and controversial. Depending on the size and location of these formations in the spleen, surgical correction is possible in open or laparoscopic surgery, or conservative (non-invasive) management. The result of SC treatment should be the complete elimination of the cyst cavity. Purpose - to evaluate the results of surgical correction or conservative management of CS in children according to remote monitoring changes. Materials and methods. We conducted the study on 265 children aged 0-17 years (mean age 11.25±4.21 years), who were examined and treated for SC. One hundred seventy-five (66.04±2.91%) children underwent surgery, and 90 (33.96±2.91%) patients received conservative treatment. We subjected all the information recorded in the medical records to statistical processing. The mentioned information could characterize the situation with the treatment process and with dynamic monitoring of this pathology to some extent. Results. The most common localizations of cysts were the upper (33.21±2.89%) or middle segments of the spleen (29.81±2.81%). Almost every fourth patient (27.92±2.76%) with SC had pathology of other organs or systems, and every tenth (9.81±1.83%) had other diseases of the spleen. We detected residual cyst in 46.42±3.06% of patients; it underwent complete regression within 1-3 years. Residual cyst of small size (which persisted after surgical correction) regressed much faster after surgery compared with regression of cystic formation of small size in the spleen with conservative management (p<0.05). Conclusions. Therapeutic tactics for SC in children involve different options for individual surgical correction or conservative management, depending on the location, size, relationship to the architecture of the main vessels and the variant of damage to the parenchyma of the spleen. The outcome of treatment of children with SC depends on the volume, location, etiology of the lesion, the method of correction and compliance with all recommendations in the postoperative period against the background of comorbidities. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: splenic cyst, children, surgical treatment, conservative management, results.

Congenital cyst in female accessory spleen: a case report

Cysts found in splenic stores, of parasitic or non-parasitic origin, are rare causes of recurrent abdominal pain, but with a significant increase in the number of diagnoses in recent years. This condition is caused by the derivation of the mesothelial cell lining of the spleen capsule, occurring in 0.5 - 2% of the world population. Clinically, patients tend to remain asymptomatic for years and usually have an incidental diagnosis by imaging exams or during the investigation of diffuse and recurrent abdominal pain, rarely found in females. The treatment of splenic cysts is performed through video laparoscopic splenic resection.

Treatment of splenic cysts

: 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.

Лапароскопічне лікування кіст селезінки у дітей

Лапароскопічне лікування кіст селезінки у дітей

English

A 19 years-old male who presented with upper abdominal discomfort of one-year duration. Imaging revealed a huge splenic cystic. Splenectomy was undertaken. Pathological examination revealed an epidermoid cyst. INTRODUCTION: Splenic cysts are an uncommon encounter in surgical practice and less than 1000 cases have been reported [1,2]. Most patients with splenic cysts experience minor, nonspecific symptoms related to the mass effect of the cyst. The diagnosis is made by taking a thorough patient history, conducting a physical examination, and evaluating ultrasonography. Rupture, haemorrhage, and infection, which may be life-threatening, have been reported [3]. CASE REPORT: A19yrs old male patient, student, non-smoker, presented with upper abdominal discomfort and dull pain in left upper abdomen of one year duration. The patient had no history of trauma. On examination, there was a single, cystic, non-ballotable intra-abdominal lump in the left hypochondrium that moved with respiration. The routine biochemical and hematological investigations were normal. Spleen was enlarged reaching upto the umbilicus. Ultrasound showed a huge splenic cyst, which had two components; an upper multilocular component and a lower unilocular one. Laboratory tests were normal. Injection Pnemovac was given 2 weeks prior to surgery. Exploratory laparotomy was undertaken. The spleen was huge (Figure 1 & 2) and toughly adherent to the posterior abdominal wall. It was almost completely replaced with the cyst but the wall or splenic rim of tissue was thick. Tortuous dilated veins were found at the hilum. After freeing the adhesions with blunt dissection delivery of the spleen was done, control of the splenic artery and vein through lesser sac secured further dissection, mobilization and extraction. The patient had an uneventful postoperative course. Pathological examination revealed an epidermoid cyst. DISCUSSION: The treatment of splenic cysts is a difficult challenge to surgeons [4]. Not surprisingly with the classification, diagnostic modalities and treatment guidelines are far from being uniform or clear. Three classification systems are present Fowler, Martin and Morgenstern [5]. Discovery of the cyst is easy with imaging modalities but the true nature and pathology of the cyst is not always possible to determine preoperatively [6]. Since the pathology dictates management, decision making for the ultimate management is still personal. Preoperative aspiration of the fluid for biochemical and cellular examination is debatable. Some recommend it routinely [4] while others see it is contraindicated and hazardous [2]. A wide range of treatment modalities have been described for symptomatic or very large cysts of the spleen. Non operative measures, such as observation, have been recommended for asymptomatic cysts smaller than 5 cm. The natural history of these small cysts is largely unknown,

Image-guided Percutaneous Splenic Interventions

In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.

Laparoscopic Partial Splenectomy for Splenic Epidermoid Cyst

The treatment strategy of the splenic cyst is controversial. Better understanding of the splenic segmental anatomy, need of splenic conservation, and advances in laparoscopic skills has made laparoscopic partial splenectomy a preferred treatment for splenic cysts. In this paper, we report a case of splenic epidermoid cyst managed successfully by laparoscopic partial splenectomy. Also, results of various treatment strategies were reviewed.

Congenital Splenic Cyst Treated with Percutaneous Sclerosis Using Alcohol

We report a case of successful percutaneous treatment of a congenital splenic cyst using alcohol as the sclerosing agent. A 14-year-old female adolescent presented with a nonsymptomatic cystic mass located in the spleen that was believed to be congenital. After ultrasonography, a drainage catheter was placed in the cavity. About 250 ml of serous liquid was extracted and sent for microbiologic and pathologic studies to rule out an infectious or malignant origin. Immediately afterwards, complete drainage and local sclerotherapy with alcohol was performed. This therapy was repeated 8 days later, after having observed 60 ml of fluid in the drainage bag. One year after treatment the cyst has practically disappeared. We believe that treatment of splenic cyst with percutaneous puncture, ethanolization, and drainage is a valid option and it does not rule out surgery if the conservative treatment fails.

Splenic Cysts

The treatment of splenic cysts is a difficult challenge to surgeons and physicians. This paper reviews the literature on splenic cysts, with special attention to the pathogenesis, diagnosis, and various options of surgical treatment. Splenic cysts are classified as primary or secondary cysts, according to the presence of an epithelial lining. The primary cysts are further subdivided as parasitic or non-parasitic. Secondary cysts are in most cases posttraumatic. Symptoms are usually correlated to the size of the cyst. Prior to surgery, imaging with ultrasound and computer tomography or magnetic resonance should be performed. A cyst puncture should be conducted for diagnostic purposes (amylase and bacteria) as well as to reduce the size of the cyst. Furthermore, the titer of Echinococcus and other biomarkers can be measured. Surgeons should make every possible effort to preserve splenic tissue and spleen-saving techniques with laparoscopic techniques are recommended.

Laparoscopic Argon-Beam Coagulation in Relapsing Congenital Dysontogenic Splenic Cysts

We operated on a 13-year-old girl with an upper abdominal mass caused by growing congenital dysontogenetic cysts in the lower part of the spleen. The first operation was done laparoscopically using a bare Nd:YAG laser fiber and the Harmonic Scalpel. All cystic material was removed, and the surface of the remainder of the spleen was covered with greater omentum. Because of relapse within weeks, the operation had to be redone 3 months later. This time, the remaining splenic surface was treated with a 5-mm laparoscopic argon-beam coagulator. No relapse has occurred in the ensuing 2 years. Any laparoscopic use of the argon-beam coagulator carries a risk of argon gas embolization. Despite this risk, with appropriate precautions, the coagulator is a very helpful tool for the treatment of splenic cysts.

Laparoscopic splenic cystectomy: A case report

Congenital epidermoid splenic cysts are very rare. They are known to become symptomatic as a consequence of enlargement, hemorrhage, rupture, or infection. Recent options in the treatment of splenic cysts have included percutaneous drainage, partial splenectomy, or open splenic cystectomy. The authors present the first report of a pediatric patient with a large epidermoid cyst of the spleen treated by laparoscopic partial cyst excision and omental packing. Follow-up at 1 year confirms no recurrence. Laparoscopy provides a minimal access method of obtaining pathological confirmation of diagnosis, reduction of cyst complications, and a short hospital stay, while preserving splenic function.

Cystic Lymphangioma of the Spleen

Splenic cysts are uncommon, with fewer than 600 cases reported in the world literature. This report concerns a case of cystic lymphangioma of the spleen, consisting of a large splenic cyst with associated multiple, small, subcapsular cysts and lymphangiectasia. The cysts are lined by endothelium, and they conform to the characteristics of dilated lymphatic channels. Lymphangioma of the spleen is thought to arise from congenital obstruction of lymphatic flow, with subsequent dilatation of lymphatic channels. The diagnosis and treatment of splenic cysts are discussed and a new classification of splenic cysts is proposed.