Hydatid disease of spleen treated by cyst enucleation and splenic salvage

A 4-year-old boy with unilocular hydatid cysts of spleen and liver was successfully treated by enucleation of both the cysts and salvage of the spleen. The conventional surgical treatment of choice for hydatid cyst of the spleen is splenectomy. The authors demonstrate that preservation of a spleen afflicted by hydatid disease is technically feasible and is recommended as the choice of treatment to obviate the well-recognized postsplenectomy complications especially in children.     

The laparoscopic spleen-preserving approach to splenic cysts: advantages and limitations

INTRODUCTION: Due to the multiple functions of the spleen the preferred management of cystic non-parasitic lesions is nowadays laparoscopic partial splenectomy or decapsulation with preservation of the spleen. We have analysed our patients with non-parasitic cystic lesions and the current literature to weigh the benefits and complications of these methods in children and adults. PATIENTS AND METHODS: Laparoscopic partial splenectomy was performed in three children with dysontogenetic cysts. Laparoscopic marsupialisation was performed in one child and in three adults. RESULTS: Follow-up in the true cysts showed no recurrence in one patient and one residual cyst in the second. In the third patient, splenectomy was performed because there was not enough residual spleen to warrant preservation. In the group with post-traumatic cysts, no complications or recurrences were observed. DISCUSSION: The laparoscopic spleen-preserving approach for the treatment of non-parasitic cysts is feasible, but challenging. The main problem is a recurrence rate of more than 20 %. The reason for recurrence remains uncertain: it is probably due to different operative strategies, the morphology of the cysts or the presence of residual cysts. The recurrence rate in post-traumatic cysts is low on the basis of our own experience and a literature survey. CONCLUSION: The benefit of laparoscopic treatment in true non-parasitic splenic cysts has to be weighed against the rate of recurrence. A complete resection of the cysts should be attempted. In post-traumatic cysts, laparoscopy offers a good minimally invasive treatment option.     

Non-parasitic cysts in children - peculiarities in surgical management - report of three cases

Aim-Background

Non-parasitic cysts of the spleen are rare and usually random findings that are treated by a variety of surgical methods. The aim of our study is to present our experience in children and to point out the peculiarities in comparison with those of adults.

Method-Material

In the last two years, three children aged 14, 10, and 11 years respectively were treated in our clinic for non-parasitic splenic cysts. In two cases, the cyst was revealed during a check-up for abdominal pain, and in the third during tests for urine infection. In all cases, the diameter of the cysts exceeded 6 cm. In case one, we performed a cystectomy, in case two a partial splenectomy and in case three a total splenectomy.

Results

In all cases, the operation was uncomplicated. However, there was a significant difference in the number of days of hospitalization and in the short-term and long-term medication. Histologic examination found the cysts to be epidermoid in cases one and two and of post-traumatic origin in case three.

Discussion

The spleen-preserving surgical methods are the methods of choice in children due to the significant immunological role of the spleen at young ages. The basic criteria for the selection of the surgical management were the position and the size of the cysts.     

Epithelial cysts of the spleen]

The Authors report a case of epithelial cyst of the spleen-observed in a 25 years old woman. After remembering the nomenclature and pathogenetic hypothesis, they consider clinical patterns of this rare disease of the spleen which is usually found in children and young adults. The Authors discuss pathological findings, diagnostic aids, especially non-invasive imaging. They also suggest considering the cysts in diagnosis of the diseases of the spleen and splenectomy as a treatment of choice.     

Laparoscopic treatment of large true cysts of the liver and spleen is ineffective

True epidermal cysts of the liver and spleen are uncommon and it has been recommended that laparoscopic management is appropriate. Often these cysts are large and centrally located by the time they reach clinical significance thereby making complete excision difficult without major liver resection or splenectomy. Definitive therapy consists of drainage and complete resection of the cyst wall. Three patients presented with upper abdominal pain. Workup revealed large non-parasitic true cysts of the liver (one) and spleen (two). All were initially treated with laparoscopic resection of their cysts with the primary objective being organ preservation. They were followed with periodic ultrasound/CT scanning. The pathology report in all three cases demonstrated benign congenital epithelial cysts and the patients did well postoperatively. Despite meticulous dissection and marsupialization of the cysts all three patients experienced recurrence that necessitated further therapy. We conclude that laparoscopic surgery is inadequate in the management of true cysts of the liver and spleen unless complete removal of all cyst wall can be assured.     

Epidermoid splenic cyst--state of the art

In order to understand the features of splenic epidermoid cysts and their possible associated complications, four cases of splenic epidermoid cyst are presented in this report, two in children, one of them appeared in a child affected by a EBV and BH sepsis complicated with splenic abscesses due to scratch cat disease. The other two cases were adults. According to our histophatological findings, the pathogenesis may be related to a citodiferentation from mesothelium to squamous metaplasia. Our current knowledge about the role of spleen on immunological activity, mainly against capsulated germs, and the increase risk of overwhelming postesplenectomy septicemia have contributed to our conservative attitude about splenic surgery. We believe that management during the neonatal period should be conservative because cysts tend to disappear in most cases. In older children with a small cyst our recommendation is punction-aspiration and sclerotherapy, with ultrasound follow-up control.     

Giant congenital infected splenic cyst: An interesting case report and review of the literature

Splenic cysts are rare lesions. The congenital non-parasitic cysts of the spleen are rarely met in the clinical practice. Primary cysts have a cellular lining that can be caused by congenital events or parasitic infection (Echinococcus). Secondary cysts have no cellular lining and may be of hemorrhagic, serous, inflammatory, or degenerative origin. We report a rare case of congenital cyst of spleen in a child aged 10 years treated successfully by splenectomy because of total involvement of the splenic parenchyma along with involvement of hilum by the cyst, and we review the literature.     

Post traumatic pseudocyst of the spleen: case report on a conservative management through percutaneous drainage

Non-parasitic cysts of the spleen are uncommon and often result from blunt abdominal trauma. These lesions are classified as splenic pseudocysts. Until recently, splenectomy has been the primary choice of treatment of these pseudocysts. The trend for treatment of spleen cysts is now towards a conservative management. The case reported herein is an example of a post traumatic splenic pseudocyst successfully treated with a conservative approach (ultrasound aided percutaneous drainage). In most tropical countries, also in view of lack of resources and expertise, a conservative non-surgical of post-traumatic spleen cysts management could be appropriate and feasible under certain circumstances.     

Familial Epidermoid Cysts of the Spleen: Report of Two Cases

The familial occurrence of epidermoid cysts of the spleen is rare, with only six cases having ever been reported, to our knowledge. We recently diagnosed epidermoid cysts of the spleen in a mother and son. First, a 15-year-old boy was admitted to our hospital for management of blunt abdominal trauma. Computed tomography (CT) showed a ruptured large splenic cyst with an intraabdominal hematoma. We performed a splenectomy, and histopathological examination confirmed the existence of an epidermoid cyst of the spleen. About 2 years and 6 months later, the family physician found that the patient's 41-year-old mother had a large splenic cyst, and she was referred to our hospital for further investigation. CT showed a 10 × 8 cm cyst occupying most of the spleen. The patient underwent splenectomy, and a pathological diagnosis of an epidermoid cyst of the spleen was confirmed. Although the etiology of epidermoid cysts of the spleen is unclear, this familial occurrence may support the hypothesis of congenital malformation as a result of genetic change.     

Laparoscopic splenopexy and cystectomy for an enlarged wandering spleen and splenic cyst

Wandering spleen is an uncommon condition, which can present emergently in children. Similarly, nonparasitic splenic cysts are also rarely encountered. In this report, we describe a massive wandering spleen (22 cm in longitudinal dimension) with a pseudocyst (4.6 × 2 cm) in the inferior pole in an asymptomatic 16-year-old adolescent. Only 4 similar cases have been reported in the literature; 2 of them have been in the pediatric age group. These 2 conditions were diagnosed while she was being evaluated for dysmenorrhea, and she was referred for surgical consultation. The cyst was excised laparoscopically, and the spleen was placed into an extraperitoneal pouch. To date, there are no other reports describing laparoscopic cystectomy and splenopexy in a teenager.     

Diagnosis and treatment of splenic pseudocysts

Seven patients with pseudocysts of the spleen were treated in the clinic of the 2nd chair of surgical diseases of the Riga Medical Institute. The cysts in all of them lacked characteristic signs and were recognized late, when they had grown to a large size. Ultrasonic examination and computerized tomography played the main role in establishing the diagnosis. The pseudocysts of the spleen were treated by surgery. In large cysts splenectomy was the operation of choice, though organ-preserving operations (enucleation of the cyst, resection of the spleen) were suggested.     

Serous cysts of the spleen treated by laparoscopic surgery

The authors present two case of a 25 years and 32 years old male patients with serous cysts of spleen that were detected on an random abdominal ultrasonography. Abdominal pain in the left hypocondrium was only symptom of this patients. The patients was operated by laparoscopic method, with Ultra-Shears and intraoperative ultrasonography examination. This kind of techniques give us the opportunity to performed the ablation of the cysts with preservation of the spleen with fast full recovery.     

儿童肠系膜囊肿和大网膜囊肿临床诊疗分析

目的总结儿童肠系膜囊肿和大网膜囊肿的临床诊治经验。方法回顾性分析我院收治的大网膜囊肿和肠系膜囊肿共34例患者的临床资料。结果本组肠系膜囊肿25例,大网膜囊肿9例。所有患儿均行手术治疗,术后均恢复满意,术后10d内治愈出院。术后无出血、感染、梗阻、肠瘘等近期并发症。结论儿童肠系膜囊肿和大网膜囊肿足儿童少见疾病,尽管手术治疗效果佳,但是还需要进一步提高诊断准确率,避免误诊。     

Giant epithelial cyst of the accessory spleen

Splenic cysts are uncommon, and cysts derived from the accessory spleen are rare. We report a case of a huge splenic cyst derived from the accessory spleen in the omentum, concomitant with multiple epithelial cysts of the primary spleen. Both serum and cystic fluid concentrations of carbohydrate antigen (CA)19-9 were markedly elevated. A huge monolocular cyst occupied the entire abdomen. A total of 7 l of aspirated cystic fluid was turbid and yellowish-brown. The cyst wall, which consisted of CA19-9-positive squamous epithelium, contained approximately 2 × 3 × 1 cm of splenic tissue. There was a separate multicystic 16 × 8-cm spleen in the normal position. The CA19-9 serum level returned to normal postoperatively. Received: May 6, 2002 / Accepted: November 29, 2002 RID="*" ID="*" Offprint requests to: H. Takikawa     

Laparoscopic treatment of hydatid cysts of the liver and spleen

Background: The short-term results from laparoscopic treatment of hydatid cysts of the liver and spleen were reported previously. The procedure was shown to be feasible and safe, offering the advantages of laparoscopic surgery. This is the first report on the long-term follow-up of this operation in a large group of patients. Methods: In this study, 108 hydatid cysts of the liver and spleen in 83 consecutive patients (43 males [52%] and 40 females [48%]) were approached laparoscopically. The mean age of the patients was 40 years (range, 13–85 years). There were 104 liver cysts and 4 spleen cysts. The liver cysts were located in the right lobe in 42 patients (53%), in the left lobe in 21 patients (26%) and in both lobes in 16 patients (21%). Of the 104 cysts, 44 (42%) were uniloculated and 60 (58%) were multiloculated. Results: All cysts were approached laparoscopically. The mean operative time was 80 min (range, 40–180 min). The conversion rate was 3%. The mean hospital stay was 3 days (range, 2–7 days). There were no mortalities, and complications occurred in nine patients (11%). All were managed conservatively except one patient in whom a laparotomy was needed. All patients were followed up for a mean period of 30 months (range, 4–54 months) with serological testing and ultrasonography if needed. In three patients (3.6%) recurrence of the disease developed. Conclusion: The laparoscopic approach to uncomplicated hydatid cysts of the liver and spleen is a safe and effective option with favorable long-term results. Received: 27 August 1998/Accepted: 13 July 1999     

Comparison of pulmonary hydatid cysts in children and adults

BACKGROUND: The purpose of the present study was to compare the clinical features and the surgical approaches of the pulmonary hydatid cysts in children and adults. METHODS: One hundred and thirty-four patients, operated on for pulmonary hydatid cysts over the last 10 years were retrospectively evaluated in two groups: 39 children who were younger than 18 years old (29%) and 95 adults (71%). The patients in each group were analysed according to their clinical, radiological and surgical findings. RESULTS: The frequency of pulmonary hydatid cysts in children was significantly higher in boys (74%) than in girls (26%). However, there was no sex tendency in adults (52% in male vs 48% in women). The sex difference in hydatid cyst frequencies between adults and children was significant (P < 0.05). Among preoperative pleural complications, pneumothorax (15.5%) in children and empyema (11%) in adults were more frequent. The frequency of concomitant hepatic cysts was less in children than in adults (33%vs 79%). Huge pulmonary cysts (=10 cm) were more common in children (31%) than in adults (22%). Cystotomy with capitonnage was the most frequently preferred method in both groups. Postoperative complications developed in six children (16%) and 19 adults (19%), and were more frequent in patients with huge cysts (27%vs 16%). No recurrence was observed in both groups. CONCLUSIONS: Isolated pulmonary cysts are more common in children than adults. The cysts also tend to be bigger in children than adults. The frequency of concomitant hepatic cysts is less in children. Because of higher lung expansion ability and improvement capacity in children, resection should be avoided and lung saving surgical procedures should be performed. In spite of differences observed in the clinical features it does not change the treatment of pulmonary hydatid cysts in children.     

Conservative surgical treatment of splenic cysts

The common treatment of splenic cysts is splenectomy, but with today's knowledge of the important position of the spleen in the infection defense, it is advisable to preserve the spleen whenever this is possible, especially in younger individuals. A large non-parasitic, benign splenic cyst is excised. Postoperative ultrasound control presents a normal appearance of the spleen.     

Splenic cysts: aspiration, sclerosis, or resection

Percutaneous aspiration and tetracycline sclerosis is a safe but temporary therapy of large splenic cysts in children. Between 1985 and 1987, three girls with splenic cysts were seen. Their ages ranged from 5 to 14 years, and the cysts were from 8 to 16 cm in diameter. Despite their large size, all were asymptomatic and were discovered upon physical examination or ultrasound for unrelated conditions. All cysts were avascular by scan and had irregular crenated or smooth walls by ultrasound. Further investigation excluded infectious or parasitic causes. Each cyst was aspirated for diagnosis, and a pigtail catheter was inserted for drainage and sclerotherapy. All needle aspirations resulted in cyst collapse, but in one patient the pigtail catheter insertion was unsuccessful, and in the other two cases, multiple attempts of tetracycline sclerosis failed to obliterate the cysts. There were no other complications. Surgery for the recurrent splenic cysts was performed 3 months to 2 years following the percutaneous procedures. The two patients operated on with 3 months of aspiration underwent successful partial splenectomy and have normal splenic function by ultrasound scan, and absence of RBCs. The third patient had progression of the cystic disease throughout the spleen, and required splenectomy. Pathology confirmed multiseptate congenital mesothelial cysts in the first two patients and massive lymphangiomatosis in the third. In all three cases, percutaneous therapy was safe but did not result in long-term control. In one patient, the cystic disease progressed following sclerotherapy and may have influenced the need for complete splenectomy. Prior manipulation did not adversely affect the dissection and mobilization of the spleens.(ABSTRACT TRUNCATED AT 250 WORDS)     

Partial laparoscopic decapsulation of splenic cysts: long-term results

The aim of this study was to evaluate the role of laparoscopic decapsulation in the management of splenic cysts. Cystic disease of spleen is an infrequent entity. Laparoscopic surgery should be considered as the method of choice for the greater of patients diagnosed with a splenic cyst. We provide 2 new cases of splenic cysts treated with partial laparoscopic decapsulation using harmonic scalpel. The patients were examined 5 years later and no cysts recurrence was found.     

小儿原发性脾脏肿瘤13例临床分析

目的：探讨小儿原发性脾脏肿瘤的临床特点及其治疗。方法：回顾分析1970年1月-2001年12月收治的13例小儿原发性脾脏肿瘤的临床资料。结果：13例中脾血管瘤5例，脾淋巴管瘤4例，脾囊肿2例，脾恶性淋巴瘤2例。良性肿瘤中行脾切除术4例，部分脾切除术7例；有2例脾切除术后1年频发呼吸道感染，其余恢复良好。脾恶性淋巴瘤2例者行脾切除术，术后辅以化疗；1例术后生存23个月，1例术后8个月仍随访。结论：小儿原发性脾脏肿瘤术前诊断主要依靠B超和CT；良性肿瘤术中应尽量保留部分脾脏，脾切除术后2年内应观察感染的临床表明；恶性淋巴瘤应采用以手术为主的综合疗法，早发现、早治疗是提高其生存率的唯一希望。