Symptomatic Giant Primary Nonparasitic Splenic Cyst Treated with Laparoscopic Decapsulation: A Case Report and Literature Review
Challenging differential diagnosis, Rare disease
Salah Termos, Feras Othman, Ali Aljewaied, Afaq Mahmoud Alkhalil, Mohammad Alhunaidi, Socrates Mathew Parayil, Fahad Alabdulghani
Department of Surgery, Al-Amiri Hospital, Kuwait, Kuwait
Am J Case Rep 2020; 21:e927893
Available online: 2020-10-06
Primary nonparasitic splenic cysts (PNSC) are unusual epithelial fluid lesions of the spleen. They are considered congenital cysts and are often discovered incidentally in young people. Larger cysts can be symptomatic and are traditionally managed with splenectomy. This report is of a woman with a large symptomatic PNSC that was managed surgically by laparoscopic decapsulation.
CASE REPORT: A 22-year-old Lebanese woman presented with left upper-quadrant pain, left pleuritic pain, food intolerance, and significant weight loss. Investigations showed a 20×17×15 cm cystic lesion in the spleen. Secondary causes were ruled out and tumor marker and hydatid serology were unremarkable. Laparoscopic decapsulation of the cyst with spleen preservation was performed with no perioperative complications. The patient’s 3-year follow-up visit revealed no clinical or radiological recurrence.
CONCLUSIONS: True congenital splenic cysts are rare clinical findings. Generally, they do not have malignant potential. The development of minimally invasive techniques has shifted the trend toward splenic salvaging procedures. Literature review revealed an acceptable recurrence rate with near-total rather than partial unroofing. Laparoscopic decapsulation can be a safe and adequate therapeutic option in selected cases.
Keywords: Laparoscopy, Epithelial Cyst, Decapsulation, PNSC, Primary Nonparasitic Splenic Cyst