Laparoscopic Approach to Primary Splenic Cyst: Case Report and Review of the Literature

Abstract

Splenic cysts are rare benign lesions of the spleen, often asymptomatic and incidentally discovered during imaging studies. While many splenic cysts remain asymptomatic and do not require intervention, surgical management becomes essential in cases of symptomatic cysts, large cysts, or when malignancy cannot be ruled out. Laparoscopic surgery has emerged as a minimally invasive and effective approach for treating splenic cysts, offering advantages such as shorter hospital stays, reduced postoperative pain, and faster recovery. In this case report, we describe our experience with laparoscopic surgery for a symptomatic splenic cyst in a young patient.

Keywords: laparoscopy; pseudocyst; splenic cysts.

Figure 1

Ultrasound examination. The spleen with an area measuring 10/90 cm hypoechoic, homogeneous, well delimited, suggestive of an intrasplenic cystic lesion.

Figure 2

MRI examination (coronal T2, axialT2, axialT1 postcontrast). Voluminous fluid lesion of 10 cm diameter, with a discretely irregular thin wall, homogeneous fluid content, hypersignal T2, T1 hyposignal, without gadolinophilia.

Figure 3

CT examination (axial /reconstruction in the coronal plane) native and postcontrast. The spleen with a voluminous lesion of 98/100/97 mm (AP/T/CC), with liquid densities, with calcifications on the contour and without postcontrast changes, occupying the upper 2/3 from the spleen. No adjacent vesicles are present. The lesion exhibits a discrete mass effect on the gastric fornix.

Figure 4

Laparoscopic intraoperative aspect. In the left hypochondrium, a white lesion, under tension, occupying the upper pole and the inner edge of the spleen was highlighted.

Figure 5

Laparoscopic intraoperative aspect after mobilization of the greater omentum.

Figure 6

Laparoscopic intraoperative aspect. Isolation of the lesion with gauzes richly soaked with betadine^® 20%.

Figure 7

Laparoscopic intraoperative appearance, direct approach through aspiration puncture of the cavity with the highlighting of the liquid with a macroscopic serous appearance.

Figure 8

Laparoscopic intraoperative aspect. Fenestration of the cyst.

Figure 9

Laparoscopic intraoperative aspect. Inspection of the cavity, trabecular appearance of the wall.

Figure 10

Laparoscopic intraoperative aspect. Cavity drainage with drainage tube.

Figure 11

Microscopic appearance of the resection piece. Calcium deposits and acicular cholesterol crystals highlighted by arrows.