The Mangement of Splenic Cysts in Children

Introduction: Tumors of the spleen are rare in children, but they present a wide range of diagnostic, histological and radiological appearance. Splenic cysts are far more common than solid lesions. Cysts may be congenital (epidermoid cysts), infectious (abscess or hydatid cyst), or neoplastic (lymphangioma or angioma with tumor necrosis). They are most often asymptomatic. Diagnosis can usually be established with the clinical context and radiology (ultrasound, CT, MRI). Different options for the management of splenic cysts are available to the pediatric surgeon, ranging from simple monitoring to surgical excision. Minimally invasive surgical techniques and spleen conservative surgery have made splenic surgery less aggressive.

The aim of the study was to describe the clinical and paraclinical characteristics of splenic cysts in children, and to assess their management.

Patients and Methods: In a retrospective study within the pediatric surgery department in tunis, Tunisia, we have collected five children with a diagnosis of splenic cyst during the last decade. We specified for each patient the functional signs and physical examination data, ultrasound and CT were done for the patients, specifying the location and the size of the cysts. Hydatic serology was done when the parasitological origin was suggested. After surgical management and histological confirmation, the follow–up was based on clinical examination and abdominal ultrasound.

Results: They were three girls and two boys. The average age is ten and a half years. All patients were symptomatic with abdominal pain. The size of the cysts was significantly increased in all patients with an average of 11 cm. Surgery was indicated for all cases. Three patients had cystic resection and two had partial splenectomy. The histology objectified epithelial cyst for three patients and hydatid cyst of the spleen for the other two cases. The subsequent outcome was favorable for all patients with a current mean follow-up of three years.

Conclusion: Splenic cysts are rare in children and their management is still controversial. In splenic cysts, imaging can give clues to the diagnosis, but it often requires pathological examination of the part. Resection should be as limited as possible in order to avoid the risk of total splenectomy.