Rare co-existance of disease or pathology
Takehisa Matsuyama, Toshimasa Nakao, Shumpei Harada, Tsukasa Nakamura, Shuji Nobori, Hidetaka Ushigome
Department of Transplant Surgery, University Hospital Kyoto Prefectural University of Medicine, Kyoto City, Kyoto, Japan
Am J Case Rep 2019; 20:1138-1140
Splenic cysts are rare. Most are due to previous trauma, infection, or infarction. They are generally handled by laparoscopic surgical removal if they are larger than 5 cm. However, very large cysts may require splenectomy. Another factor in the choice of therapy is the patient’s underlying condition. We present the case of a giant splenic cyst in a woman 1 year after a renal transplant.
CASE REPORT: A 28-year-old woman presented with acute abdominal pain and nausea. One year before, she had received an ABO-identical living donor renal transplantation from her father, and was maintained on oral tacrolimus and prednisolone. A CT scan with contrast showed enteric ileus and an abnormal position of the spleen, which was involved by a cyst measuring 12×12.5×9 cm. A nasogastric tube, and later a small bowel tube, were inserted to decompress the ileus. The patient underwent laparotomy 11 days after admission. We confirmed an internal hernia with volvulus due to migration of the spleen; however, there was no evidence of necrosis. The patient was treated with splenectomy and reduction of the hernia. There were no complications.
CONCLUSIONS: This was a very unusual emergency following renal transplantation. Splenectomy has been performed in the past for immunosuppression in cases of donor ABO-incompatibility. We therefore considered that it would be more expedient to remove the spleen than to remove the cyst and perform splenopexy.
Keywords: Hernia, Ileus, Intestinal Volvulus, Spleen