Thursday, January 22, 2009
This was a young patient who was sent to me for chronic left upper abdominal pain. She also complained of early satiety and occasional nausea. After about her third or fourth ER visit, a CT scan was obtained which showed a 6x7 cm benign-appearing splenic cyst (pictured above) with some compression of the adjacent stomach.
The cyst did not have the characteristics of a malignancy (septations, calicified wall, etc) and she was symptomatic, so I proposed a laparoscopic partial cystectomy. Splenic preservation is paramount in benign splenic disease, especially in a younger patient. So that's what we did. The surgery went beautifully. Once the cyst was decompressed by needle aspiration (yellow/green fluid) I incised the cyst wall and then divided it circumferentially with the Harmonic scalpel in a relatively bloodless manner. The wall was sent to pathology for a frozen section to rule out malignancy and while we waited I cauterized the aspect of the cyst left in the splenic parenchyma (Argon laser is another option).
Once the path confirmed a benign epidermoid cyst, we took out the ports and closed up shop. Twenty minute case. Fun stuff....