Laparoscopic cystectomy for a giant splenic cyst in a 8-year old child

Abstract

   Introduction. Nonparasitic splenic cysts (PNSC) are rare, with a frequency of 0–2 % of all diseases of the spleen. Primary cysts account for about 30–40 % of all spleen cysts and are more common in children than in adults. Most cysts are asymptomatic. The usual clinical picture of large spleen cysts includes: pain or discomfort in the upper left abdomen, often accompanied by a feeling of overflow in the stomach. Spleen cysts larger than 5 cm are more prone to complications such as bleeding, rupture or infection, therefore surgical treatment is recommended. Development of endoscopic surgical techniques and modernization of imaging diagnostics have significantly changed management of spleen cysts. Thorough and accurate preoperative examination, precise location and topography of the cyst and surrounding structures increase chances for an organ-spearing surgical intervention. Nevertheless, in some cases, splenectomy is the only possible way of radical treatment. To date, the following types of intervention are most commonly applied: percutaneous cyst puncture with sclerotherapy, partial resection of the spleen and cyst fenestration which may be made both endoscopically and in the traditional way.   Description of clinical observation. This article describes a clinical case of a giant spleen cyst revealed at the outpatient examination for abdominal pain. The child was hospitalized. During the inpatient examination, asymmetry of the abdominal wall was found; a densely elastic rounded formation was palpated in the left hypochondrium. The patient was thoroughly examined: ultrasound of the abdominal cavity which revealed a cystic formation of the spleen and MRI. ELISA test did not reveal antibodies to Echinococcus. Laparoscopic cystectomy was performed.   Conclusion. This clinical case is an example of modern approach to the surgical treatment of giant non-parasitic spleen cysts with minimally invasive and organ-sparing tactics.