Jara Hernandez Gutierrez, Aurelio Francisco Aranzana Gomez, Beatriz Muñoz Jimenez, Juan S Malo Corral. CH Toledo
Introduction: Splenic hamartoma is a rare benign tumor, of which about 150 cases have been described in the literature since it was first described by Rokitansky in 1861. It is usually a casual finding in laparotomies or autopsies. They are usually asymptomatic, but there are few symptomatic splenic hamartomas and they can be associated with haematological alterations, being in some cases associated with spontaneous splenic rupture and acute abdomen, two thirds of them have multiple tumors.
There are no specific data that allow the preoperative diagnosis of this entity, which is performed after the anatomopathological study of the surgical specimen, which must be extracted entirely, this together with the size of the spleen makes the laparoscopic approach difficult.
The aim of this video is to demonstrate the surgical technique of a complete laparoscopic approach for this type of lesions, without the need for assistance laparotomies (handport).
Methods and Procedures: Clinical case: A 44-year-old man admitted to Internal Medicine due to fever and left lumbar pain. Additional explorations of interest are discussed, including: Thrombopenia of probable peripheral origin secondary hypersplenism (FNA of bone marrow) , CT: Splenomegaly with 4 splenic masses, which deform the splenic contour, compatible with atypical hemangiomas, without being able to discard other vascular splenic tumors.
Results: Complete semi-laparoscopic approach, 4 trocars, Multilobulated splenomegaly (19×16 cm.), mechanical vascular section, complete bag extraction after minilaparotomy on the left flank. The patient presented a successful postoperative recovery, being discharged on the 4th PO day. Abdominal ultrasound at 1st week with portal vein thrombosis, which resolves after treatment with heparin. Definitive result of the specimen: multiple splenic hamartoma. Asymptomatic one year after surgery.
Conclusion(s): The laparoscopic approach is a valid and effective alternative to splenic benign tumor lesions. The size does not contraindicate this type of approach, although the complete extraction of the spleen is recommended for its pathologic study. We recommend eco-Doppler control per week, given the risk of portal thrombosis with an existing laparoscopic post-splenectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94418
Program Number: V264
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop
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