Total Splenectomy due to an Unexpected "Complication" after Successful Extended Laparoscopic Partial Decapsulation of a Giant Epidermoid Splenic Cyst: A Case Report

Abrupt elevation of tumor marker levels in a huge splenic epidermoid cyst, a case report

Epidermoid cyst of the spleen is a rare disease, and relatively few cases were reported by literatures. Most published case reports provided inadequate information on the impact of splenic epidermoid cyst on tumor markers. A 32-year-old woman with a giant splenic epidermoid cyst was reported, for whom the serum concentration of a collection of tumor markers (CA19-9, CEA, CA125, CA242, and CA50) increased abruptly accompanied by left upper abdominal pain for 5 days. After comprehensive preoperative examination and multidisciplinary team discussion, we ruled out any concurrent malignancy and a laparoscopic total splenectomy was performed, during which the splenic cyst spontaneously ruptured unexpectedly. After surgery, the elevated serum tumor marker levels decreased sharply until reaching normal range 3 months later. Learning from the case, we conclude that interval monitoring of serum tumor markers is of critical value for patients with splenic epidermoid cyst. Abrupt elevation of tumor marker levels and abdominal pain may serve as signs of cyst rupture, which is strongly indicative of surgical intervention as soon as possible. Total removal of the splenic cyst is strongly suggested considering the recurrence and malignant potential of the splenic epidermoid cyst.

Challenges in the management of a splenic pseudocyst by laparoscopic splenectomy in an adult patient: A case report

INTRODUCTION AND IMPORTANCE

Splenic cysts are classified as true cysts, or pseudocysts, and larger cysts tend to be symptomatic, requiring management which has evolved to include spleen-sparing procedures to minimize the risk of overwhelming post-splenectomy sepsis (OPSS) Pitiakoudis et al. (2011), Hansen and Moller (2004), Knook et al. (2019) [1-3]. Total splenectomy remains the gold standard management, and the importance of this case is the uncommon spontaneous occurrence of a pseudocyst, and the importance to pre-operatively consent and prepare the patient for total splenectomy would intra-operative conditions not allow for spleen-preserving techniques.

CASE PRESENTATION

CS, a 21-year-old lady, had two presentations to the emergency department with left upper quadrant abdominal pain. The only abnormality on assessment was a large splenic cyst on CT scan, which increased in size on re-presentation. She was consented for a splenic cyst fenestration, and for total splenectomy and optimized with vaccines would intra-operative conditions not allow for spleen-sparing. During the operation, the planes between the cyst and spleen parenchyma were ill-defined, and decision was made to proceed with total splenectomy to avoid bleeding complications. She recovered well, and was discharged 5 days post-operatively, and histology confirmed a pseudocyst (Figs. 1 and 2).

CLINICAL DISCUSSION

The management of splenic cysts remains difficult and with no clear guidelines to uniform treatment. There are multiple spleen-preserving techniques developed to avoid OPSS (Agha RA, Franchi T, Sohrabi C, Mathew G, for the SCARE Group, 2020 [4]), however management remains individualized and case-specific.

CONCLUSION

Pseudocysts can occur without splenic trauma or infarct. Management is case-based, and patients with large symptomatic cysts should be consented and prepared for total splenectomy would conditions not be safe for spleen-preserving interventions.

Symptomatic Giant Primary Nonparasitic Splenic Cyst Treated with Laparoscopic Decapsulation: A Case Report and Literature Review

Patient: Female, 22-year-old

Final Diagnosis: Primary nonparasitic splenic cyst

Symptoms: Abdominal pain • mass in abdomen

Medication: —

Clinical Procedure: Laparoscopic decapsulation of giant splenic cyst.

Specialty: Surgery

Splenic epithelial cyst mistaken with Hydatid cyst: A case report

INTRODUCTION

Cystic lesions of the spleen are infrequent and usually diagnosed incidentally. These lesions are rare and their differential diagnosis is very wide. Splenic epithelial cysts are the most common type of primary splenic cyst (4%). Surgical treatment is indicated for cysts larger than 5 cm or symptomatic. Nowadays, spleen preserving surgery is the gold standard treatment considering the immunologic role of the spleen and the increased risk of post-splenectomy infections.

CASE PRESENTATION

A 17 year old girl presented to the outpatient clinic with moderate left upper quadrant abdominal pain of 2 weeks duration with loss of appetite and denied fever, chills, sweating and jaundice. Abdominal examination showed tender splenomegaly. The abdominal imaging (Ultrasound, CT SCAN, MRI) was suggestive of hydatid cyst of the spleen, for which she received Albendazole for 1 month and then operated by laparotomy with partial resection and un-roofing of the splenic cyst. The pathology report showed a splenic epithelial cyst (SEC).

CONCLUSION

SEC is a rare pathology that could mimic splenic hydatid cyst. The clinical and radiological pictures may be commonly misleading and non-conclusive. Definitive diagnosis is made on histopathology. Spleen conserving surgery, when possible, is the preferred modality for treatment.

Splenic pedicle control during laparoscopic de-capsulation of a giant splenic cyst

Splenic cysts are a rare entity in the Western population and are either true cysts (primary, 25%) or pseudocysts (secondary, 75%) complicating trauma, haemorrhage or infarction. Congenital or simple splenic cysts are the commonest primary cysts and surgery is recommended for cysts larger than 5 cm as these are prone to infection, bleeding or rupture and for symptomatic or complicated cysts. Splenic preservation techniques using the laparoscopic approach are the most prevalent. We present a case of a giant painful simple splenic cyst treated with laparoscopic de-capsulation with application of a new technique for achieving vascular control, whereby control of the splenic pedicle was achieved using a Nylon tape. This approach was safe and well tolerated with a total splenic ischaemia time of 30 min and a successful result. The patient was discharged with no antecedent complications and no recurrence of the cyst at 6 months follow up ultrasound scan.

Total laparoscopic splenectomy for giant epidermoid cyst: a case report

INTRODUCTION

Splenic cysts are benign tumors, accidentally detected using US or CT scan. They are classified into true cyst (primary, 25%) and pseudocyst (secondary, 75%). Conventional treatment of splenic cyst, especially giant, symptomatic and complicated has been open or laparoscopic total splenectomy. Recently, partial splenectomy is recommended as well to preserve its hematopoietic function and homeostasis of blood, but it is not considered safe for complications as intra and post operative bleeding.

CASE REPORT

A 46 years old man, martial arts practitioner, underwent US abdomen scan because of left upper quadrant pain, with evidence of a splenic mass. He underwent also CT and MRI, which revealed "oval giant splenic mass of 12 cm diameter located in superior splenic pole that can be firstly referred to cyst". Considered patient's frequency to thoraco-abdominal traumas, we decided to perform a total laparoscopic splenectomy. Surgical treatment was performed with a three trocar technique and lasted 150 minutes. Post-operative follow-up was regular and abdominal drain was removed in 4th POD (Post Operative Day). Patient was discharged in 5th POD. Pathological examination revealed epidermoid cyst.

CONCLUSIONS

Total splenectomy needs to be performed in cases of giant cyst and in our limited experience it is a safe approach.

Epidermoid cyst of the spleen

BACKGROUND

The aim of this study is to elucidate the characteristics, clinical presentations, and management of epidermoid cysts located in the spleen and the intrapancreatic accessory spleen.

METHODS

Data pooled for analysis were collected from epidermoid cyst cases encountered in the study institution and sporadic case reports obtained from the English literature.

RESULTS

There were 115 cases of epidermoid cyst. Seventy eight (67.8 %) were found in the spleen, whereas 37 (32.2 %) were found in the intrapancreatic accessory spleen. Comparing between the two groups, the splenic group showed female predominance, younger age, and larger cystic size. For symptoms, left upper abdominal mass (57.7 %) and left upper abdominal pain (39.0 %) were more commonly found in the spleen group. Meanwhile, the intrapancreatic accessory spleen group had higher percentage of asymptomatic cysts (59.5 %). As for surgical indication, majority of patients in the spleen group underwent surgery for symptomatic relief (75.4 %), while the intrapancreatic accessory spleen group underwent surgery mainly for suspicious malignancy (90.0 %).

CONCLUSIONS

Surgical treatment for epidermoid cysts of the spleen is considered the optimal treatment for either alleviating the symptoms caused by a bulky cyst or for determining the histopathologic nature of a suspicious malignant cystic neoplasm.