Hand-assisted laparoscopic splenectomy for a splenic hamartoma

Laparoscopic extirpation of splenic hamartoma

We presented a case of splenic hamartoma. A 12-year-old girl has had an abdominal pain since 9 years of age. Contrast-enhanced computed tomography scan at a local hospital revealed heterogeneous enhancement of a mass which is 5 cm in diameter, located near the surface of the spleen, diagnosed as hemangioma. She had an investigation with Levovist-enhanced ultrasonography and superparamagnetic iron oxide-enhanced magnetic resonance imaging on T2-weighted gradient-echo imaging, which showed a hypervascular echoic mass and a decrease of signal intensity. The imaging diagnosis was splenic hamartoma. She underwent laparoscopic splenectomy to prevent the spontaneous rupture. The splenic artery at the pancreas body was exposed, and doubly ligated by vessel clip and furthermore ligated by 3-0 silk. At the splenic hilum, the splenic artery and vein were dissected with the Endo GIA vascular linear cutting stapler. The spleen was captured into the Endocatch II retrieval bag and removed from a transverse lower abdominal (suprapubic) incision extended up 7 cm in length through a port site. In pathological findings, the tumor was compatible with hamartoma. Splenic hamartomas in pediatric patients have been described extremely rare. In clinical symptoms, spontaneously ruptured splenic hamartoma has been rarely reported.

Hand-assisted laparoscopic splenectomy for splenic vascular tumors: report of two cases

We report 2 cases of splenic vascular tumors that were successfully treated by hand-assisted laparoscopic splenectomy. Two patients, a 41-year-old woman and a 33-year-old man, were admitted to our department for investigation of a splenic tumor. After ultrasonography, computed tomography, and magnetic resonance imaging, we suspected that the masses were hemangioma or inflammatory pseudotumor in the spleen. However, we preoperatively could not rule out the possibility of a malignant neoplasm because they each had previously undergone surgical treatment, one for cervical cancer of the uterus and the other for testicular seminoma. Hand-assisted laparoscopic splenectomy was safely performed for the diagnosis and treatment of the splenic tumors. A histologic diagnosis was venous hemangioma and littoral cell angioma, respectively. Hand-assisted laparoscopic splenectomy may be a good indication for splenic vascular tumors that are difficult to diagnose preoperatively whether they are malignant or benign.