Postoperative recurrence of splenic epithelial cyst; treatment with subtotal splenectomy.

Abstract

Three children were operated upon for congenital epithelial cysts of the spleen in the five-year period 1983-1987. Their mean age was 9.8 +/- 2.3 years. Two of them were boys. They comprise 1.6% of the surgical pathology of the spleen in our hospital, which is a Reference Centre for congenital haemolytic diseases. Two of the children had been suffering from intermittent colic pain in the left hypochondrium with a tender palpable mass for a short while to the present day. The third patient was asymptomatic; a splenic cyst with calcification of its wall was accidentally revealed by a plain x-ray of the abdomen. Contrast gastrointestinal studies and intravenous pyelography helped us with the diagnosis; they indicated a splenic mass that caused visceral displacement adjacent to the spleen. Ultrasonography proved the cystic nature of the enlargement of the spleen in all the cases. Marsupialization was performed in one patient and removal of the cysts in the other two. All three patients were followed up and re-checked 1-5 years postoperatively (May-June 1988). In one boy who underwent removal of the cyst four years ago, recurrence of the splenic cyst was revealed by ultrasonography, CT scan and radionuclide scan. Subtotal splenectomy was performed. The remaining upper pole is supplied with blood by the short gastric arteries. The recurrence was attributed to coexistence of invisible tiny cysts that had remained in the splenic tissue after the dissection of the major cyst during the previous operation. Subtotal splenectomy is an acceptable alternative procedure for splenic cysts.