Thursday, January 22, 2009

Splenic Cysts




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....

40 comments:

OHN said...

Another happy customer :)

rlbates said...

Sounds like a very sweet case!

Bongi said...

nice

Anonymous said...

But did the symptoms resolve?

Buckeye Surgeon said...

Anon-
So far.....

DHS said...

20 minutes? you have a very fast lab. the last frozen section I was involved in, it took longer than that just to get stuff to and from the lab.

Anonymous said...

I have a laprascopic picture of a 7.5 cm splenic cyst if you want it to post.. Its MUCH BETTER than ultrasound pics. I tried looking them up when I found out my 15 yr old son had one.,.. First cyst came back after just cyst removed.. second time had to take spleen out. He had same symptoms but was found by palpatation by pediatrician then ct scan and ultrsound...

Anonymous said...

I have a 6 x 8 cm cyst in my spleen that was noticed when I had an ultrasound checking for an appendix problem. I went to my doctor and to a surgeon which the surgeon said to leave it alone and because there's many problems when working with the spleen (bleeding)... I told me that what's on the net doesn't tell the whole story....

I'm in no pain but trying to research as much possible... It seems that there's not many successful operation preserving the spleen only complete removal? any answers?

Anonymous said...

Well, I had another CT scan last Thursday and will find out if the cyst has enlarged? I was told the next step is to get a biopsy but there's a risk of bleeding then removal! Any other methods?

Anonymous said...

My son has been c/o severe epigastric pain that wakes him up; 3 md's said it was anxiety; we just found a small cyst in the spleen; he has other symptoms which may be related...I'm nervous..we are going to a specialist..any suggestions?

Buckeye Surgeon said...

Anon 10/6-
Small splenic cysts highly unlikely to be source of your son's symptoms.

evilgurl said...

my son is 20 & had some severe pain. at the ED they decided to do a CT because everything else was normal & found a spleen cyst that is 9x7x7. they said he needs surgery & they would try to reserve the spleen. reading your description eased my mind. everything else i've read scares the hell outta me.

Nawar said...

Jeff I was researching the topic of spleen cyst and found your blog, if I may please ask you a question, for the last 2.5 months I have been having daily terrible spikes of pain in my left mid and upper back, sometimes the pain would radiate through out my shoulder and I even feel it in my left arm, in addition at times I have upper abdominal discomfort but nothing close to the back/shoulder pain. As a result I have undertaken a CT Scan, and the report showed this:

“The spleen is not enlarged. There is however an 8mm diameter low-density area peripherally in the spleen on the posterolateral aspect of the anterior portion of the spleen. The nature of this is uncertain”

My doctor and the radiologist does not think much of it, and they don’t believe it is the cause of my symptoms, the only treatment I was offered is pain killers (amitriptyline); I am not sure what to do since the doctor is not really helping as he believes this cyst is insignificant, do you believe that my pains and this cyst is a coincidence? Or do you think they are related? What do you advice I do next?.

Thank you very much for your time,
Regards,
Nawar

TomR said...

Hi I'm wondering if you can help. For 3 months prior to finding a Cyst on my spleen (ultra sound scan) I had problems digesting food and passing stools. The pain presented itself in the bottom of my left rib and left side of my colon as well as the middle and left side of my spine. Other symptoms include numbness in my right thigh and left abdominal muscle spasms.

My doctor is convinced the cyst and the problems I am having are unrelated. However I have recently read that an enlargement of the spleen or cyst can cause displacement on the stomach and colon. Although rare might this be possible for my symptoms and if so what are the treatments?

I'm a bit annoyed as this has been going on for 6 months. I've lost 3 stone in weight, and I have to take daily pain killers. Other tests such as blood tests and a clonoscopy have came back fine but I believe these are not looking in the right areas.

Anonymous said...

I have a 10yr old daughter with an 8cm cyst on spleen after visits with many docs we finally have been referred to a pediatric surgeon on Monday. She has no pain but this cyst goes thru the middle of her spleen. Is the likelyhood they will remove the spleen just because of the size?

the quiet one said...

Hi Everyone. Guess what? Yup, I've got a splenic cyst. It's 11.5cm by 11.4 cm by 13cm. I just found out on Monday.

My question, Dr. Parks, is: What kind of surgeon should I consult with? I saw a general surgeon and he seemed baffled. This made me feel even more scared.

Or, if you have any recommendations of surgeon in the Los Angeles area, please let me know.

~Sandra

Anonymous said...

I too had a splenic cyst back in October 2007. My surgeon laprascopically unroofed the cyst. 3 years later, I am feeling the same symptoms I did the first time. Pain in the upper left rib cage which is caused from the cyst laying on the diaphragm. I thought I was done with this chapter in my life, guess not - here we go again! I really wanted to try and save the spleen.

Anonymous said...

After two months of treatment for left shoulder pain, I was rushed to the ER with abdominal pain. BP 198/111, WBC 27000. CT showed 9cm cyst in my spleen. Three days later, docs drained 500cc brown fluid(very painful) and loaded me down with anitbiotics. A week later, nothing had grwoth per pathology. Still have no idea what caused this or will it return. WBC back to normal...still slight abdonimal and shoulder pain.

Anonymous said...

My 17 year old daughter has been complaining for 1 month of a pain in her left shoulder that radiates to her left ribcage and she has difficulty breathing. Her episodes lasted 2 to 3 days and lessened after each day. After two trips to emergency room, and after being told she had pleurisy and muscle spasms, I took it upon myself to bring her to a cardiologist. Her heart is fine, but they found a 9.5x8.0x9.6 cm cystic lesion on her spleen. She is scheduled for surgery next week to have the cyst removed. They surgeon said the cyst would continue to grow if we leave it in. We can't ever remember her having any type of injury to her spleen that would result in this cyst. Can't really find any information on removal of cystic lesions other than the one Buckeye Surgoen spoke about. Any information would be appreciated.

Anonymous said...

Our 16 yr old son presented with left shoulder pain and shortness of breath. CT scan identified an 8x8.4x7.4 size cyst on his spleen. It is positioned posterirly and superiorly. This location is not very conducive for the dr.

We have seen three surgeons, each with varying objectives. One surgeon is absolute about removing the entire spleen. He feels due to the position under the diaphragm and the size of the cyst this is the safest solution. He feels by leaving a wall of the cyst it will return and then our son will face another surgery to finally remove the spleen.

The next surgeon is a pediatric surgeon and his objective would be to preserve the spleen and remove as much of the cyst as possible by doing very much same procedure as Buckeye Surgeon did on this original post. This pediatric surgeon feels there would be about a 10-15% chance of reoccurance of the cyst. It is not definitive but cyst appears to be congenital, so who knows how long it took to grow to this size?

As his parents we are perplexed with which route to go. We are leaning toward preservation of the spleen. Even if it only buys him a few more years.

Anyone have any more experiences with this type of situation?

Dr. Buckeye, I would be glad to send you a copy of the CT scan for an opinion too! :)

Jessica said...

im 19 i have a 13x 11 cyst in my spleen....

Anonymous said...

I was told back in December of '10 that I have a 13.5X16.4X17.8cm cyst on my spleen.

I have to have surgery to have it removed this Monday (1-31-11).

I get really bad shoulder pain. And here recently, I've been having really bad neck pain. Can the size of the cyst cause the neck pain, too?

They are going to try to do a laparscopic surgery, but they say it still can turn into an open surgery.

Jessica said...

I had my cyst removed in january it was 11x13 by the end of February beginning of March i started gettin shoulder pain again and then i started to notice that my spleen was swelling up and i was feeling the way i had before i was informed that it was a cyst. By mid march my cyst had returned and at that time it was bout 3cm.. i was told there was no sign of cancer which was great but i was probably born with it.
They had put a put a lining of fat where my cyst had started hoping that it would help it from not coming back. Surgeon thought i was crazy when i told him i had signs of it coming back.
I go back next month to see how much my cyst has grown since March. I do not wish this on anyone at all it is horrible. The surgery was not fun at all and the days after sucked.

Anonymous said...

hi
i got a 8cm cyst on my spleen i had it drain once already when it was 10cm they took 230mls out of it but after 2 weeks it come back and it hurts twice as bad then the first time my surgeon team that i am going through said i will be waitting 2- 3 months to have it remove and i am worryed that it will bersh what can i do to get in sooner

p.s i have 2 young childern under 3years old that i have to look after and it is very had to look after then

thank you for your time i hope to hear from you soon

Jessica said...

so my cyst is now 11cm...surgeon wont do surgery yet...could the cyst harm my immune system?? just wondering cuz i know the spleen helps fight infections so i was wondering if the cyst could stop it from fighting infections...my cyst isnt on the outside of the spleen like it seems like most are..mines actually in my spleen

jiya said...

hi, iam 29 weeks pregnant and having a larga cyst with 17cm x15cm ,i have already had a laproscopy , but it came again. iam jus so worried abt my pregnancy, just hope it will not cause any complications during my pregnancy. pls help me and my unborn!!!!!

jiya

Anonymous said...

Well, I posted on this thread Feb. 20th 2009 with a spleen cyst which I still have and is increasing in size at very low rate...Now, I'm starting to get pressure points in my back (not pain) and to date no new developments on dealing with spleens cyst other than removing just like in the 1800's. All these new tools and the surgeons answer is removal? Any bright educated answers?

Anonymous said...

I dont think I have spleen cysts but a lesion on my spleen that they saw on the CT last night. They are sending me for an MRI next week. I have fever on and off for a month and pain in my upper left tummy area. Any suggestions on what this could be? Should I be worried?

blogger2011 said...

I stumbled upon your site while researching splenic cysts. I found out last August that there is a 6.6cm cyst on my spleen. It was found accidentally and I left it alone because the ER doctor didn't seem worried and didn't recommend me to see my PCP or a Specialist. Then I went to my gyno yesterday and asked about the cyst and if she could shed some light on the subject. She looked up my history and found that when I was in the ER a cyst was found on my spleen but no orders were given as to what to do with it. She said not to worry because if there was something to worry about they would've told me. Well, curious, i started to research and everything I find tells me otherwise. Can you please give me some advice? I don't have the symptoms others seem to have but I'm worried this could turn into something and I'd rather have it taken care of before anything truly bad happens.
Thanks so much

Anonymous said...

hey there i am a 18 year old male with a 8x6 cm cyst on my spleen, yesterday i went to the emergency part of the hospital an had an x ray showing 6 staples in the top left part of my rib cage.. he said it was from when i was 8 an had the cyst burst (not the first time ive had them i guess) but my spleen is in the lower part of my abdomen.. any explanations, im having severe pain by my heart or on my heart and lower left abdomen, and he said i dont have to worry it should be fine.. but im skeptical cause it reallllly hurts? shed any light?

Anonymous said...

My ct scan showed decreased attenuation within the liver 5 mm cyst in the inferior aspect of right hepatic lobe 8 mm splenic cyst adjacent to the peritoneum there is a 3. Cmx1.8 cmx3.6 cm partially cystic lesion with enhancing internal septation and enlarged lymph nodes and benign appearing fatty hilum and small subcentimeter bilateral inguinal lymph nodes. No one seems to think it is a big deal and I can not keep spending money and do not know where to begin with what to do with my pain. So I have stopped going to the dr. Untill symptoms get worse because dr. Said sometimes symptoms need to get worse before diagnoses. I feel dizzy and weak but have a appetite.

Anonymous said...

Well, it's been about 3 years since the discovery of my spleen cyst which has been increasing at a very slow rate.... I'm not reading any new developments on preserving the spleen but the same old 1800's method of choice "splenectomy"...? Can the surgeon that produces this forum shed some light on the subject of new procedures, surgeons on the cutting edge...anything????

Anonymous said...

A couple of years ago I had a cyst on my spleen. I was active in sports but didn't know of any time when trauma may have caused the injury. The pain was especially felt in my left shoulder but began hurting in the upper left side (front and back) of my abdomen. I initially thought the pain in my shoulder was a badly pinched nerve or my back being out of alignment, but it was actually the spleen sending pain signals through the nerve that runs from the diaphragm up to the shoulder (known as referred pain). It was painful to lean back in a chair, to lay down, to breathe deeply, and sometimes movements in general (like the vibrations caused from walking).

After a year or so, and as the cyst grew, the pain and discomfort got to the point that I eventually went to the emergency room. They did a CAT scan and found a large cyst on my spleen. Soon after they did a peculation to drain the cyst and see if that resolved it. They drained a liter of fluid out of the cyst! It was mostly comprised of old blood (no cancer or anything). Unfortunately, the cyst came back and they had to result to surgery. Initially my doctor thought he was going to have to remove the spleen, but he decided to call around for second opinions (thank you doc!). He found an alternative solution and ended up doing a laparoscopic procedure that removed the cyst and then he burned the surface of the spleen to try and prevent it from coming back. It worked. I still have my spleen today.

Anonymous said...

In 2005, I was down with mild fever for 5 days and I admitted myself to hospital. They did a check up and ultrasound and said I had a splenic cyst about 7cmx8cmx8cm. Initially doctor asked me to remove my entire spleen. I was not so agreeable to such drastic measure so he did a drainage instead. The cyst reduced in size and I was finally discharged after 5 days. After a month I came back for a follow up and they found that the cyst had filled up back to the same size. I had no pain and I have no other symptoms till this day and it has not cause me any discomfort or pain what so ever.

Anonymous said...

Nine years ago I had laproscopic surgery to deroof a large splenic cyst. It was causing a lot of pain after eating. Now I find it's back and bigger (15cm x 12cm x 10cm). Suprisingly I'm fairly asymtompatic expect craming on the left side while running. I was going to have the cyst drained and then put alcohol in to help kill the membrane cells since the surgey did not work and I want to keep my spleen. Has anyone tried this? There is too much of a shared membrane with my spleen to really remove a lot of the membrane w/o spleen removal. Also, has anyone had surgery twice with the cyst not returning the second time?

whiskas said...

20 years ago, when I was 14, they discovered a huge splenic cyst. They initially drained, and it grew back quickly. The second time, they drained it and put some alcohol in it to irritate the lining of the cyst. Again, it grew back. The third time, they put more alcohol in, and it apparently did the trick.
However, they did not do a follow-up CT scan at the time to actually check what it looked like afterwards.
So...fast forward 20 years to last year, where I felt some mild discomfort in the area, had a CT scan, and yes the cyst was still there, however much smaller. But it was very calcified (possibly from all the alcohol).
I went to a few different doctors/surgeons, some said to remove the spleen altogether. Another said if possible, it would be good to try and preserve the spleen.
So I opted to drain it and do the alcohol, which wasn't successful as the cyst grew back.
Anyway, now I'm just not sure what to do. One idea that's been suggested to me is: Laparoscopic fenestration with omentopexy.
It seems some people have had success with laparoscopic procedures.
Here'a a link to an article about a ten-year study of lapascopic treatment of splenic cysts:
http://www.ingentaconnect.com/content/sls/jsls/2007/00000011/00000001/art00004

Thanks!


Anonymous said...

I'm curious too if anyone has ever done a second surgery and had it successful. I had mine splenic cyst deroofed back in 2007 and I'm feeling symptoms again. Really would like to keep my spleen!

Kirs71 said...

Advice please. I have been told I have a calcified splenic cyst 13cm in my spleen. The registrar I saw (+ my Dr) have not seen this before!
Confused and worried, I have upper left abdominal and back pain with swelling & fatigue.
Thanks in advance.

Diana said...

Not sure is anyone is still checking this, I have a splenic cyst 15cm x 14.4cm x 13cm found accidentally during an ultrasound. I have had left shoulder pain for years and occasional left abdo pain but because I wwasn't having the ultrasound for those reasons the Dr didn't want to touch it. I have a follow up booked for 3 months but I wonder if removing it would help with my shoulder pain and bad acid reflux. The radiographer noted that it appeared to be pushing my stomach up. Should I get a second opinion to see if it should be removed

Diane Cranston said...

HELLO

A 54 year old non smoking non drinking white female, was recently treated for sinus infection with anti biotic. She is now being treated for pleurisy with anti biotic. She has a splenic cyst with calcification around it, 5 cm.
Without seeing her in your office, what can you tell us? I thank you most kindly, John