What causes a splenic cyst?
- Patients can be born with a splenic cyst- congenital
- Can be due to cancer of the spleen
- Parasite infection
- Trauma in the past
- Splenic infections with malaria, tuberculosis or mononucleosis
What are the symptoms of a splenic cyst?
- Most patients do not have any symptoms and it is picked up on a scan performed for other reasons
- Painless mass in the abdomen on the left hand side where the spleen lies
- Enlarged spleen on examination
- Early satiety
- Nausea
- Vomiting
- Bloating
- Weight loss
- Abdominal pain in the upper/left sided abdomen
- Left kidney may be affected leading to protein in the urine
- Abnormal blood results due to the spleen being affected
How are splenic cysts diagnosed?
- Ultrasound of the abdomen.
- CT scan with also assess for involvement of other structures inside the abdomen.
- MRI of the abdomen.
- US guided biopsy can be attempted when the diagnosis is unclear and there is a concern of cancer.
What are the treatment options?
- No intervention is an option especially when the cyst is less than 5cm and is asymptomatic
- An ultrasound can be used to remove the fluid within the cyst by passing a needle through the skin. There is a high risk of the cyst coming back with this procedure.
- Surgical treatment can either be an open procedure or key hole (laparoscopic procedure). Both procedures involved “de-roofing” the cyst which entail removing the upper aspect of the cyst. This allows for removal of all the contents of the cysts and reduces the risk of it reforming. In some instances part of the spleen may be removed with the cyst. If there is significantly bleeding during the operation or partial removal of the cyst is deemed too difficult the entire spleen may have to be removed.
What are the risks surgery?
- Infection
- Pain
- Intra or post procedure bleeding
- Damage to other organs within the abdomen including the bowel, liver, stomach etc
- Need for partial or complete splenectomy
- Bowel perforation
- Conversion to open surgery
- Collections and sepsis
- Wound complication: infection, breakdown and hernias
- Complications related to a prolonged operation/anaesthetic including clots in the legs, lungs, brain or heart
How long will I be in hospital and what is the recovery period and follow up?
- Recovery is dependent on the reason for admission.
- In the instances where the cyst is drained via a needle through the skin, overnight admission may not be required
- In the instances where surgery is performed to de-roof the cyst or when a partial/complete splenectomy is performed inpatient stay may be 5-7 days.
- Patients are usually kept nil by mouth for the first day or two and then the oral diet is slowly built up from clear fluids eventually to a normal diet on discharge.
- In the instances of a partial splenectomy, splenic function and immunity needs to be closely monitored as post splenectomy vaccinations may be needed
- In instances where a complete splenectomy is performed life-long penicillin and post splenectomy vaccines 2 weeks post-surgery is needed.
- Skin clips may be used on the abdominal incisions which will need to be removed 14 days from the day of surgery.
- No heavy lifting or strenuous activity for 6 weeks
- Patients will be followed up 4-6 weeks after surgery
