Results of Surgical Treatment of Non-Parasitic Splenic Cysts in Children

BACKGROUND: Non-parasitic splenic cysts is a rare pathology in children, accounting for 0.5–2% of all splenic diseases. Typically, most cysts, as a rule, are asymptomatic However, as the cyst is enlarging, clinical symptoms — such as pain, discomfort in the left abdomen, and nausea — may appear. These symptoms are indicators for surgical intervention. Splenic cysts larger than 5 cm have a higher risk of complications such as rupture, bleeding, and infection; therefore, surgical treatment is recommended in these cases. Some authors consider the surgical intervention to be appropriate for cysts sized greater than 4 cm. However, small size of splenic neoplasms can complicate their visualization and surgery, thus increasing the risk of intraoperative complications and recurrences. Currently, in cases of borderline sizes of asymptomatic non-parasitic splenic cysts, it is recommended to assess the dynamics of size changes, so as to find the optimal curative tactics for the patient. CLINICAL CASE DESCRIPTION: Two clinical examples of non-parasitic splenic cysts in children are discussed in the article. In the first case, a splenic formation with diameter 40 mm was found in a 5-y.o. girl; the diagnosis was confirmed at ultrasound and computed tomography examinations. At the recommended dynamic follow -up , it was found out that the cyst decreased to 5 mm in diameter. In the second case, a 14-y.o. boy was hospitalized for an elective surgery, because a splenic formation was diagnosed at the regular dispensary check-up. Ultrasound and computed tomography examinations of the abdominal cavity revealed a cyst of 45 mm on the visceral surface of the upper segment of the spleen. Laparoscopy failed to visualize the splenic cyst. The follow-up monitoring with a repeated ultrasound examination of the abdominal cavity in 3-6 months was recommended. Imaging diagnostic techniques have confirmed that cyst location and size remained unchanged. CONCLUSION: The two described clinical cases demonstrate the importance of dynamic follow-up monitoring in case of borderline-sized non-parasitic splenic cysts in children, as it helps to avoid unnecessary surgical interventions.

A nonparasitic cyst of the spleen in children — is surgery a must? Two clinical cases

Teslenko,

Chundokova,

Ushakov

et al. 2024

Criteria for the Selection of Technologies for the Surgical Treatment of Children With Nonparasitic Spleen Cysts

Bataev

Belyaeva

et al. 2019

In the period from 2000 to 2017, 52 children aged from 2 to 17 years, were operated for non-parasitic spleen cysts. Along with general clinical examination, the preoperative observation included enzyme immunoassay with Echinococcus diagnostics, determination of the serum level of carbohydrate antigen CA19-9, ultrasound, CT scan or MRI, spleen angiography. Evaluation of treatment results, along with clinical examination, was based on echographic monitoring using spleen mass ratio calculation technology and laboratory tests, including the study of serum immunoglobulins A, E, M, G. Depending on the location and pool of vascularization, 4 clinical and morphological variants of spleen cysts were selected - the upper, middle and lower parts of the organ, the region of the spleen's collar. Quantitative estimates of the pathological formation included small (up to 50 ml), medium (50-150 ml), large (150-300 ml) and giant (more than 300 ml) volumes of the cyst cavity. Three main minimally invasive surgical technologies are being introduced:- navigational interventions in which access to the pathological focus and therapeutic effects on the internal structures of the cyst were carried out under the control of an ultrasound image;- combined interventions with access to the pathological focus and therapeutic effect on the internal structures of the cyst under the control of an ultrasound image in combination with endovascular occlusion of the vessels of the spleen parenchyma with X-Ray control;- laparoscopic operations, including access to pathological foci and therapeutic effects on the internal structures of the cyst, provided by the endotelevision visualization. Recovery was achieved in 47 (90.4%) patients as a result of single interventions. Repeated surgeries completed with the recovery were required in 5 (9.6%) clinical observations. Subsequent follow-up with a duration of up to 3 years of disease recurrence did not show relapses. The choice of tactics of surgical treatment of children with NCC was shown to have to be based on the results of multifactorial planning, taking into account the anatomical and topographical features of the localization and growth rate of spleen cysts. The high reparative potential of the spleen in childhood determines the postoperative recovery of the organ’s morphofunctional characteristics, regardless of the volume of the cyst present. The use of quantitative parameters to estimate the mass of the spleen makes it possible to objectify the course of the postoperative period, the effectiveness of the intervention and the adequacy of the reparative regeneration processes.

A Total Destruction of Membranes in a True Splenic Cyst in Children - An Obligatory Technique for Its Radical Removal

Katsupeev

Chepurnoy

et al. 2020

The authors describe a case when a recurrence of a true splenic cyst developed after non-radical excision of its membranes. During the second surgery, a combined surgical technique was applied for membranes destruction: diathermocoagulation, argon laser irradiation and taking a strand of the greater omentum closer to the surfaces of treated cyst membranes. Half a year later, there was no recurrence revealed at the follow-up examination. It indicates that the cyst was radically removed.