Large Splenic Cysts at the Upper Pole of the Spleen – Laparoscopic Management

LARGE SPLENIC CYSTS AT THE UPPER POLE OF THE SPLEEN – LAPAROSCOPIC MANAGEMENT (ABSTRACT): Splenic cysts represent a rather rare pathology. The traditional management consisted in splenectomy and it is performed more and more frequently by laparoscopy. However, with the recognition of the important immunological function of the spleen, new techniques to preserve splenic function as fenestration, cystectomy or partial splenectomy may be considered. The authors present the cases of 2 women of 17 and 23 years old in whom dynamic enhanced intravenous contrast computed tomography revealed 2 cystic lesions located in the upper pole of the spleen, measuring 7 and 10 cm in diameter with thin walls and homogenous low-density fluid content. Serology for hydatic cyst was negative. The patients were approached by laparoscopy in a right lateral decubitus position. In the first case, only a small area from the upper part of the cyst was visible, outside the spleen parenchyma, needle aspiration removing clear, yellowish fluid. A partial cystectomy was possible after posterior and superior mobilization of spleen attachments, removing almost two-thirds of the cystic wall with spleen parenchyma around it, to avoid recurrence. In the second case, the cyst was not visible, being completely surrounded by parenchyma. Splenectomy was decided and performed. Both cases evolved uneventfully. Histopathology report indicated epithelial cysts in both cases. The conservative laparoscopic management of large splenic cysts is more difficult when located in the upper pole and almost entirely surrounded by parenchyma. Splenectomy is safer for the patient if the true nature of the cyst could not be established before or during the intervention.