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Splenic cysts are rare and tend to have elevated tumor markers, of which carbohydrate antigen (CA) 19-9 is the most frequently elevated. Therefore, splenic cysts with elevated serum carcinoembryonic antigen (CEA) levels and without CA19-9 elevation are extremely rare. A 26-year-old woman presented with sudden upper abdominal pain while sleeping. Contrast-enhanced computed tomography (CT) showed an 85-mm simple splenic cyst in the upper pole and a moderate amount of ascites around the spleen. The serum levels of CEA, but not CA19-9, were elevated. Spontaneous rupture of a splenic cyst was diagnosed. We performed elective laparoscopic unroofing. The histological findings revealed a stratified squamous epithelium on the inner surface of the cystic wall. On immunohistochemical examination, the squamous epithelium was found to be positive for cytokeratin (CK)7, negative for calretinin, and positive for CEA. The histological diagnosis was an epidermoid cyst. Three months after the operation, the elevated serum tumor marker levels of CEA were normalized. Splenic cysts with high levels of CEA and low levels of CA19-9 are extremely rare. Laparoscopic unroofing is a useful operative procedure for ruptured splenic cysts with elevated levels of serum tumor markers.

Background Spontaneously ruptured large splenic cyst is a rare in children, and traditionally total or partial splenectomy has been performed for treating an emergent case. We herein present a first case with spontaneously ruptured pediatric splenic cyst treated with emergent laparoscopic dome resection with omental suturing to the parenchymal edge of the spleen. Case presentation A 12-year-old girl with a spontaneously ruptured large non-parasitic splenic cyst (SC) was successfully treated by emergent laparoscopic dome resection with omental suturing to the edge of the splenic parenchyma. The patient presented with acute abdominal pain and was diagnosed with a ruptured non-parasitic SC and peritonitis by contrast-enhanced computed tomography (CT). Emergent laparoscopic dome resection of the SC and omental suturing to the splenic parenchymal edge were then performed. The protruding part of the cyst wall was completely resected using an ultrasonically activated device (USAD), and the greater omentum was then sutured to the anterior edge of the splenic parenchyma under a laparoscopic view. No complications were observed during the operation. A histological examination revealed a congenital splenic cyst lined by epithelial cells. The postoperative course was uneventful, and an ultrasound scan showed no evidence of cyst recurrence at 3 years after the operation. Conclusions This minimally invasive laparoscopic procedure was feasible and effective for treating a ruptured large splenic cyst in an emergent pediatric patient.

The aim of the study is to assess the impact of the splenic hilar vasculature configuration on the amount of remnant splenic parenchyma volume after partial splenectomy for splenic cysts. The data of all patients receiving a splenectomy for a splenic cyst from 2002 to 2016 at the Center of General Surgery and Liver Transplantation of Fundeni Clinical Institute were retrospectively reviewed. The size and location in the splenic parenchyma of the cyst and the splenic hilar vasculature type were assessed for each patient with a splenectomy. Thirty-one patients with non-parasitic and 32 patients with hydatid cysts were recorded. In cases of centrally located cysts, a total splenectomy was performed for the majority of cases, while in peripheral cysts a spleen-preserving surgery was feasible for most of the patients (p = 0.001). The size of the cyst was significantly higher in the group of patients with a total splenectomy, compared with the group with a partial splenectomy (p = 0.003). In the subgroup with a distributed arterial pattern, preservation of more than 50% of the initial parenchyma was achieved in a significantly higher proportion of patients, compared with the subgroup of patients with a magistral pattern (p = 0.012). Besides cyst size or peripheral location in the splenic parenchyma, the vascular pattern is also considered another decisive factor that associates with successful conservative or minimally invasive approach.

A thorough understanding of the anatomy, physiology, and development of the spleen is essential for determining the pathophysiological mechanisms underpinning splenic diseases and congenital variations. The aim of this review is to briefly summarize current knowledge regarding the normal development of the spleen, and to provide an overview of clinically relevant congenital splenic variations. These include such variations as asplenia, polysplenia, hyposplenia, lobulation of spleen, accessory spleens, accessory splenic nodules, wandering spleen, splenogonadal and splenopancreatic fusion, splenic cysts, and cavernous haemangioma of the spleen. All of these congenital variations are also mentioned in internationally accepted embryological nomenclature, known as the Terminologia Embryologica. Interestingly, most patients who have these diseases are asymptomatic, and are often diagnosed only after an injury or during unrelated medical procedures. Using examples from published case reports, we highlight how an understanding of the embryology of the spleen and the etiology of its disease states would improve clinical practice.

A 34-year-old woman visited our hospital for treatment of a huge splenic cyst with epigastric pain. She had been diagnosed with Gaucher's disease (Type 1) at 3 years of age and had been receiving enzyme replacement therapy (ERT) from 15 years of age. Abdominal MRI showed a low-intensity area, 30 cm in diameter, with a well-defined border on T1-weighted images. The patient underwent laparoscopic fenestration of the huge splenic cyst for relief of worsening epigastric pain caused by the cyst. The cyst contained 2,500 ml of brownish-red fluid. The patient recovered satisfactorily and was discharged on postoperative day 11. Gaucher's disease is an extremely rare metabolic disease; only about 6,000 patients are registered in the International Collaborative Gaucher Group Gaucher Registry. An extremely rare case of a huge symptomatic splenic cyst treated by laparoscopic fenestration in a patient with Gaucher's disease is described.

Splenic cyst(s) may be noted as an incidental finding on conventional imaging techniques, or as a result of evaluation of a patient with left upper quadrant pain, left shoulder pain, abdominal enlargement, or splenomegaly. Lymphangioma of the spleen is an extremely rare and benign neoplasm in adults, which is characterized by cystic dilatation of the lymphatic vessels in splenic parenchyma. This report describes a case of multiple splenic lymphangiomas in a 41-year-old female. She underwent abdominal ultrasonography for a health check-up. She had no symptoms, and physical examination did not reveal any abnormalities apart from splenomegaly. Ultrasonography and computed tomography showed multiple variable-sized cysts replacing the normal parenchyma of the spleen. There were wall calcifications in several cysts. The patient underwent laparoscopic splenectomy, and the final diagnosis was multiple lymphangiomas of the spleen.

Aim-Background Non-parasitic cysts of the spleen are rare and usually random findings that are treated by a variety of surgical methods. The aim of our study is to present our experience in children and to point out the peculiarities in comparison with those of adults.

Primary splenic mucinous cystadenocarcinoma (MCCa) is extremely rare, and only six cases appear to have been reported previously. We present herein a case of primary splenic MCCa resulting in pseudomyxoma peritonei (PMP). A 66-year-old Japanese woman presented to a hospital with a chief complaint of upper abdominal pain and a 7-year history of splenic cyst. Cyst rupture was noted on computed tomography, and splenectomy was performed. The abdominal cavity was filled with a large amount of gelatinous ascites, with the appearance of PMP. On the cut surface, multiple cysts containing mucinous material were found within and outside the spleen. Microscopically, splenic parenchyma was occupied by large mucinous pools focally lined with mucinous epithelial cells and mesothelial cell-like cells, which were considered benign. Outside the spleen, a low-grade MCCa component was found. No ectopic pancreatic or intestinal tissue was identified. Although most PMP cases are known to be caused by low-grade mucinous appendiceal tumor, the present case represents the first report of a splenic MCCa resulting in PMP.

Background-Aim The aim of this case report is to present the rare case of a large splenic pseudocyst and discuss the controversy surrounding surgical treatment

Background There is a current trend to reduce the invasiveness of minimally invasive procedures, and the single-incision laparoscopic approach (SILS) has been proposed for several intra-abdominal surgical interventions. The spleen poses specific problems for techniques, such as SILS, due to its volume and texture, and little clinical information is available on the topic. We describe our initial experience using SILS for the management of splenic diseases. Methods Between December 2008 and September 2009, we attempted SILS in eight patients: four men and four women with a median age of 44 (range, 26-73) years, and body mass index of 24.5 (range, 18-31). Preoperative diagnosis was malignancy (n = 3), ITP (n = 1), HIV-related hypersplenism (n = 1), spherocytosis (n = 1), and splenic cyst (n = 2). SILS was attempted transumbilically in four cases and through a 15-mm subcostal single incision in the other four. As entry port we used either three trocars (one of 12 mm and two of 5 mm) inserted through the single-site incision or the umbilicus, or a multiport (Triport, Olympus) device. Instrumentation used consisted of curved instruments, a flexible-tip 10-mm scope, and the harmonic scalpel. Visualization of the spleen and standard dissection of attachments was accomplished, and splenectomy was completed by stapling of the splenic hilum. The spleen was extracted through the single-site incision. In two cases, unroofing of a splenic cyst was performed transumbilically. Results The SILS procedure was successful in six of the eight patients (75%). Conversion to conventional laparoscopic splenectomy (LS) was required in two patients due to adhesions and spleen size. Median operative time was 97 (range, 60-150) min. There were no postoperative complications, and median stay was 4 (range, 2-5) days. Median spleen weight was 485 (range, 340-590) g. Conclusions SILS access can be safely used for operative visualization, hilum transection, and spleen removal, further reducing parietal wall trauma. The definitive clinical, esthetic, and functional advantages require further analysis.

Primary splenic cyst is a rare disease, and therefore there is no information regarding its optimal management. Most such cysts are classified as epithelial cysts. During the last few years, the laparoscopic approach has gained increasing acceptance in splenic surgery. We present our experience with the laparoscopic (organ-preserving) management of splenic cysts. We managed 11 patients with large symptomatic nonparasitic splenic cysts from 1996 to 2006. All the patients had fullness in the left upper abdomen and a palpable mass. Preoperative diagnosis was established with ultrasonography and computed tomography. All patients were treated with either laparoscopic partial cystectomy or marsupialization. Seven patients had mesothelial cysts, two had epidermoid cysts, and two had pseudocysts. Nine patients did not have any problems or recurrence during an average follow-up of 29.5 months. Two patients had cyst recurrence after 14 months. Laparoscopic organ-preserving surgery should be the goal of therapy in most cases. Total splenectomy is reserved for cases in which cyst excision cannot be done or most of the splenic tissue is replaced by the cyst. Plication of the cyst wall edges prevents the cyst walls from adhering and causing recurrence, as well as helping to control hemorrhage. Laparoscopic partial cystectomy/marsupialization is an acceptable procedure for the treatment of splenic cysts; and after short to mid-term follow-up, it seems that a reasonable rate of success is possible.

The familial occurrence of epidermoid cysts of the spleen is rare, with only six cases having ever been reported, to our knowledge. We recently diagnosed epidermoid cysts of the spleen in a mother and son. First, a 15-year-old boy was admitted to our hospital for management of blunt abdominal trauma. Computed tomography (CT) showed a ruptured large splenic cyst with an intraabdominal hematoma. We performed a splenectomy, and histopathological examination confirmed the existence of an epidermoid cyst of the spleen. About 2 years and 6 months later, the family physician found that the patient's 41-year-old mother had a large splenic cyst, and she was referred to our hospital for further investigation. CT showed a 10 x 8 cm cyst occupying most of the spleen. The patient underwent splenectomy, and a pathological diagnosis of an epidermoid cyst of the spleen was confirmed. Although the etiology of epidermoid cysts of the spleen is unclear, this familial occurrence may support the hypothesis of congenital malformation as a result of genetic change.

Dig Dis Sci

Splenic cysts or masses in pregnancy are extremely rare and only five cases were described in the literature. We present the first case of splenic cyst in pregnancy treated laparoscopically with fenestration and preservation of the spleen.A 23-year-old primigravida at 9 weeks of gestation presented for her prenatal follow-up with a 3 weeks history of epigastric pain and early satiety. A magnetic resonance imaging of the abdomen and pelvis demonstrated a gigantic splenic cyst measuring 17 x 13 x 15 cm. Aspiration of the cyst was performed under ultrasound guidance for diagnostic purposes as well as for relief of patient's symptoms. The patient was followed by bi-weekly sonographic scan until the second trimester. A second aspiration of the cyst was complicated with sepsis, and laparoscopic fenestration and omentopexy were performed. The patient's remaining antepartum course was uncomplicated and she had a normal spontaneous delivery at thirty-eighth week.The most feared complication of a splenic cyst in pregnancy is spontaneous rupture, which in the third trimester is associated with a perinatal mortality rate as high as 70%. Surgical therapy should therefore be provided in the second trimester. Laparoscopic fenestration with omentopexy is a minimally invasive, effective and safe procedure for this condition.

In this pictorial essay the common and uncommon causes of large cystic and cyst-like abdominal masses in children are reviewed. We discuss and illustrate the following: mesenchymal hamartoma, choledochal cyst, hydrops of the gallbladder, congenital splenic cyst, pancreatic pseudocyst, pancreatic cystadenoma, hydronephrosis, multicystic dysplastic kidney, multilocular cystic nephroma, adrenal hemorrhage, mesenteric and omental cysts, gastrointestinal duplication cyst, meconium pseudocyst, ovarian cysts and cystic neoplasms, hematocolpos, urachal cysts, appendiceal abscess, abdominal and sacrococcygeal teratoma, and CSF pseudocyst. We also describe imaging features and clues to the diagnosis.

Purpose. This study was conducted to evaluate the surgical management of splenic hydatidosis in an area where the disease is endemic. Method. Over a period of 16 years, 26 patients with splenic hydatidosis underwent surgery in our department. Preoperative investigations included plain abdominal X-ray, serology, ultrasonography, and computed tomography. Results. In our series, splenic hydatidosis represented 3.5% of total abdominal hydatidosis. The majority of patients presented with abdominal discomfort and palpable swelling in the left hypochondrium. Twenty-two patients were operated on electively and 4 as emergency cases, including 2 with ruptured hydatids and 2 with infected hydatids of the spleen. Isolated splenic hydatid cysts were present in 21 patients, associated liver hydatid cysts in 4, and diffuse abdominal hydatidosis in 1 patient. All patients underwent splenectomy except for one patient who initially had partial splenectomy for a lower polar cyst. This patient also ended up undergoing a splenectomy for postoperative hemorrhage. One patient died on the sixth postoperative day (mortality rate 3.8%) as a result of multiorgan failure, and 4 developed minor complications (morbidity 15.4%). Conclusion. Splenic hydatidosis, although rare, is the third most common type of hydatidosis after liver and lung hydatidosis. This entity should thus be kept in mind when encountering a splenic cyst especially in areas where the disease is endemic. A splenectomy remains the treatment of choice because it demonstrates low morbidity and mortality rates.

Splenic cyst is extremely rare in pregnancy. All the six cases that had been described in literatures were treated surgically. However, we report the first case of a huge splenic cyst during pregnancy managed by conservative approach in the form of analgesia, antibiotics and percutaneous aspiration.

Splenoptosis is a rare condition in children. Its association with a cyst is rare. A case of splenoptosis complicated by a large cyst is reported. The child presented with features of intermittent abdominal pain, constipation and clinical examination revealed a mass apparently rising out of the pelvis. Ultrasound confirmed the mass as spleen with a 15 cm cyst in the lower pole. At surgery the cyst was marsupialised and splenopexy undertaken placing the cyst in a retro-peritoneal pouch. This is only the second report of such a case in the English literature.

We report a case of successful percutaneous treatment of a congenital splenic cyst using alcohol as the sclerosing agent. A 14-year-old female adolescent presented with a nonsymptomatic cystic mass located in the spleen that was believed to be congenital. After ultrasonography, a drainage catheter was placed in the cavity. About 250 ml of serous liquid was extracted and sent for microbiologic and pathologic studies to rule out an infectious or malignant origin. Immediately afterwards, complete drainage and local sclerotherapy with alcohol was performed. This therapy was repeated 8 days later, after having observed 60 ml of fluid in the drainage bag. One year after treatment the cyst has practically disappeared. We believe that treatment of splenic cyst with percutaneous puncture, ethanolization, and drainage is a valid option and it does not rule out surgery if the conservative treatment fails.

Percutaneous treatment of a huge congenital splenic cyst in a 23-year-old man is presented. The cyst had been catheterized and drained two times within a 3-month period without injecting any sclerosing agent into the cavity. On the third attempt, catheter drainage and injection of alcohol into the cyst cavity were performed because of insufficient response to drainage alone. He was discharged symptom-free after the procedure. The cyst diminished in size considerably 9 months after the treatment with alcohol. The volume of the cyst was reduced from 5200 to 8 ml. Although percutaneous treatment of a congenital splenic cyst with tetracyclin has been reported, to our knowledge this is the first case of a congenital splenic cyst treated with alcohol as a sclerosing agent. Percutaneous treatment of splenic cyst can obviate the need for partial or total splenectomy and may be an alternative to surgical treatment.

Background: In children, laparoscopic decapsulation of large congenital splenic cysts has occasionally been advocated, but substantial series focusing on its long-term success are still lacking. We report the follow-up experiences from two pediatric surgical centers. Methods: The decision to proceed to surgery was based on patient symptoms and cyst size (>4 cm and/or progression), after strictly exclusion of a parasitic cause (by serology and CT scan). With the use of three ports (5–10-mm) and a Harmonic Scalpel, the epithelial portion of the cyst was radically excised. The remaining hilar epithelium was coagulated carefully. After discharge, the children were examined regularly by ultrasound to detect recurrences. Results: From 1998 until 2002, eight children (mean age, 11.1 years; range, 3.1–16.4) were treated for cysts ranging from 4 to 15 cm in diameter. All procedures were completed without significant intraoperative complications (no major bleeding, no conversions). The mean operating time was 75 min (range, 56–184). Postoperatively, one child developed a cystic remnant (2 cm), which remained unchanged during 30 months of observation. After a mean follow-up of 2.2 years (range, 13–38 months), none of the patients showed any evidence of recurrent growth, and all of them had healthy splenic remnants. Conclusion: Partial laparoscopic decapsulation is an advantageous approach to large splenic cysts in children, because it is effective, preserves splenic tissue, and provides good medium-term results.

We report a case of successful percutaneous treatment of a chronic post-traumatic splenic pseudocyst using alcohol as the sclerosing agent. A 26-year-old man presented with a symptomatic cystic mass located in the spleen. Aspiration of 300 ml of fluid was only temporarily effective, and therefore a drainage catheter was placed 3 days later. After histopathologic and microbiologic exclusion of a malignant or infectious origin, local sclerotherapy with alcohol was performed because of recurrence after percutaneous drainage. This therapy was repeated six times within 2 weeks. Two weeks later, the remaining volume was determined to be 16 ml. Six months after treatment the cyst was no longer visible. To our knowledge this is the first case of a chronic post-traumatic splenic cyst treated with alcohol. Percutaneous sclerotherapy of a symptomatic post-traumatic splenic pseudocyst may be an alternative to surgical treatment.

Zysten gehoren zu den seltenen Erkrankungen der Milz. Man unterscheidet parasitare und nichtparasitare Zysten. Die sekundare, posttraumatische Form der nichtparasitaren Zysten bildet, nach den parasitaren Zysten, die zweithaufigste Gruppe. Die primaren Formen (congenital and neoplastisch) der Gruppe der nichtparasitaren Zysten sind am seltensten. Wahrend bei Milzzysten bis vor einigen Jahren die Splenektomie die Therapie der Wahl war, ist nunmehr ein Wandel im Sinne der Milzerhaltung eingetreten. Im folgenden Bericht werden an Hand einer primaren Epidermoidzyste die Atiologie, die diagnostischen Masnahmen and nicht zuletzt die therapeutischen Tendenzen in der Organerhaltung bei Milzzysten entsprechend den Entwicklungen der letzten Jahre, besprochen.

With an understanding of the spleen's important immunologic function, splenectomy for benign splenic disorders has given way to a variety of splenic conservation techniques. Treatment options for benign nonparasitic splenic cysts include partial splenectomy, total cystectomy, or partial cyst decapsulation. External cyst wall decapsulation is a simplified operative procedure that carries no increased risk of cyst recurrence. However, a conventional upper abdominal laparotomy may subject patients to significant morbidity. We successfully performed a laparoscopic partial cyst decapsulation, achieving meticulous hemostasis with use of a laparoscopic-GIA stapling device. The patient tolerated the procedure well and was discharged on postoperative day 2. Follow-up has demonstrated no evidence of recurrent cyst formation.

The spleen can be involved in a variety of cystic lesions ranging from cystic neoplasms and parasitic cysts to "true" and "false" cysts. Epidermoid splenic cyst is a rare true cyst that is developmental in origin. We present two young patients with such a cyst and illustrate their features on ultrasound, CT, and MRI with pathologic correlation.

Seven cases of small, asymptomatic splenic cyst-like lesions (CLL) diagnosed in foetuses and neonates are reported. None of these CLL was operated on; three completely disappeared. Such a complete regression has never been described before. A more conservative app approach to such lesions is suggested in order to prevent the possible complications of inappropriate interventional therapy.

Background Blastocystis sp. is one of the most prevalent parasites found in human stool and has been recently considered an opportunistic emerging pathogen in immunocompromised individuals. However, cases of invasive intestinal infections and skin rashes have been attributed to infection by Blastocystis sp in immunocompetent individuals, suggesting that it is an emerging parasite with pathogenic potential. Findings We present a case of a 22 year old female patient who complained of pain in the left hypochondrium. Ultrasonography and abdominal computed tomography scans showed two splenic cysts. The cyst fluid analysis demonstrated numerous Blastocystis sp.; PCR and DNA sequencing analyses confirmed the presence of Blastocystis subtype 3. Conclusions This is, to our knowledge, the first case report of the presence of Blastocystis subtype 3 in extra-intestinal organs and is strong evidence that Blastocystis sp. is potentially pathogenic and invasive. However, further studies are required to determine the pathogenicity of the parasite.

Hydatid disease is primarily a disease of sheep and cattle. Human beings are accidental hosts. We present a 32-year-old multigravida at 25 weeks of pregnancy in whom splenic and liver cysts were diagnosed by ultrasonography and magnetic resonance imaging (MRI). The splenic cyst was removed and a healthy baby was delivered vaginally at term.

The case of a child found to have an asymptomatic splenic cyst is presented.The child was managed conservatively with eventual resolution of the cyst.

We present two patients with splenic cysts. The first is a female 29-years-old who presented with upper abdominal discomfort of one-year duration. Imaging revealed a huge splenic cyst. Splenectomy was undertaken. Pathological examination revealed a lymphatic cyst. The second was an 18-years-old female who presented to the emergency department with a ruptured splenic cyst. Splenectomy was undertaken, it proved to be a simple cyst.

Introduction Today, laparoscopy tends to become a useful alternative to open procedure for the surgical treatment of spleen disorders, offering at the same time a conservative approach for the management of selected spleen lesions such as posttraumatic cysts. Case presentation This article describes two cases of posttraumatic splenic cysts, one of which was treated with laparoscopic total splenectomy and the second with laparoscopic cystectomy. The procedure was carried out successfully with no complications in both cases, and the patients were discharged a few days after the operation. Conclusion Laparoscopy with preservation of functional splenic parenchyma, when feasible, should be the procedure of choice in cases of posttraumatic splenic cysts, as it provides safe and definite treatment with all of the other advantages of minimally invasive surgery.

Epidermoid splenic cyst is characterised by a single layer of epithelium. Although specific findings can be depicted with ultrasonography (USG) and CT, elevated levels of carcino-embryonic antigen (CEA), CA19–9 or CA125 in serum and cyst fluids have recently been used in the diagnosis [1,2]. A 12-year-old female patient was admitted with swelling and pain on the left side of abdomen. Abdominal USG and CT revealed that the spleen was enlarged and contained two cysts. The larger cyst was very close to the hilum (Fig. 1). Serum analysis revealed high levels of CA125 (35 ng/ml) and CEA (150 U/ml). She underwent total splenectomy because the tributaries of splenic artery and vein overlaying the hilar cyst prevented an alternative operative procedure. Examination of cyst fluid also revealed high levels of CA125 (70 ng/ ml) and CEA (1500 U/ml). Both cysts were thin-walled and lined with a single layer of squamous epithelium in histologic examination. CA125 and CEA returned to normal levels within 3 months. Epidermoid cysts are lined by stratified squamous epithelium. It is thought that they develope after invagination of the capsular surface mesothelium with subsequent squamous metaplasia [3]. Mostly they give signs and symptoms in late childhood and may regress completely. Cysts larger than 5 cm require resection because of their progressive growth and in order to prevent the potential severe complications such as rupture and haemorrhage [3]. Higaki et al. [1] reported that serum CEA, CA19–9 and CA125 levels had been elevated in patients with epidermoid cyst in whom epithelium was positive for anti-CEA and anti-CA19–9 antibodies. This finding shows that these markers are products of the squamous epithelium and leak into the bloodstream, presumably as a result of trauma or increasing pressure within the cyst.

The role of laparoscopy in the stepped approach to the diagnosis and treatment of blunt abdominal trauma has not yet been fully elucidated. Despite the use of a variety of imaging modalities, it can still be difficult to make a proper evaluation in cases where there are questionable abdominal injuries. In particular, when there is a discrepancy between a bland clinical picture and the results of diagnostic imaging procedures, laparoscopy should be given preference over laparotomy, provided the patient's circulatory situation is stable. Herein we describe a case in which laparoscopy allowed the detection and treatment of a traumatic rupture of a dysontogenetic splenic cyst that had mimicked a rupture of the spleen on both the ultrasound (US) and computed tomography (CT) images.

Unsere Erfahrungen mit organerhaltenden Operationsverfahren der Milz im Kindesalter werden dargestellt. Bei 9 von 12 Kindern (75%) mit traumatischen Milzrupturen konnte das Organ ganz oder teilweise erhalten werden. Dabei wurde 4mal eine Milzteilresektion, 3mal eine Parenchymnaht und einmal eine Fibrinklebung durchgefuhrt. Ein Kind wurde konservativ behandelt. Bei einem weiteren Kind wurde eine Splenektomie mit anschliesender Autotransplantation vorgenommen. Die beiden ubrigen Patienten starben intra- bzw. kurz postoperativ an den Folgen schwerer Begleitverletzungen. Bei 11 Kindern mit einem M. Hodgkin wurde 5mal eine Hemisplenektomie vorgenommen. Das Organ wurde nur bei makroskopisch erkennbarem Befall vollstandig entfernt. Eine grose Epidermoidcyste der Milz wurde enucleiert und eine grose torquierte Wandermilz nach Teilresektion in einer Mesocolontasche im linken Oberbauch fixiert. Wegen der Gefahr einer todlichen Postsplenektomiesepsis sollte die Milz im Kindesalter nur in zwingenden Fallen extirpiert werden.

Splenic cyst was demonstrated preoperatively by percutaneous splenic aspiration and splenography. This technique has been employed in a number of previously reported cases. The procedure has been found to be helpful in the preoperative diagnosis of splenic cysts, exposes the patient to little risk, and thus far has been free from complications. The procedure should be included in the diagnostic evaluation of patients with splenomegaly of obscure origin.

The spleen is the least common intra-abdominal site for the development of cystic disease. A lymphangioma of the spleen was first reported in 1885 by Fink; since that time 47 cases of lymphangioma or lymphangectasia have been reported. Up to now, no CT study has been published. This report concerns a case of cystic lymphangioma of the spleen consisting of a large splenic cyst with associated multiple small subcapsular cysts and lymphangectasia. The utility of CT in diagnosis is presented.

A congenital splenic cysts in a 5.5 year old girl was aspirated under ultrasonographic guidance and injected with 150 mg Tetracycline (intended for IV use). Septation and gradual resorption of the cyst occurred during the following weeks, leaving small residual cysts which have remained stable for the last 12 months. Splenectomy and its possible complications were avoided.