Eri Maeda, MD1, Keiichi Okano, MD1, Hironobu Suto, MD1, Eisuke Asano, MD1, Minoru Oshima, MD1, Takayoshi Kishino, MD1, Masao Fujiwara, MD1, Naoki Yamamoto, MD2, Yasuyuki Suzuki, MD1. 1Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 2Department of Gastroenterological Surgery, Federation of Public Services and Affiliated Personnel Aid Associations, Takamatsu Hospital
Background: Carbohydrate antigen (CA) 19-9 producing splenic cysts are relatively rare, and usually occur in females and in young individuals. Surgical treatments would be considered when symptomatic cases. Recently, the approach to splenic cysts has changed towards conservative surgery, in order to prevent sepsis after splenectomy. We will describe the use of novel method for splenic preserving surgical approach in the Hybrid operating room, in order to reduce its risk of bleeding.
Case presentation: A 27-year-old woman presented to our hospital with a chief complaint of chest pain. CT showed an encapsulated left pleural effusion and multiple splenic cysts, the largest measuring 89 x 85 x 72 mm. Thoracentesis revealed its CA19-9 level was over 600,000 U/ml; cytologic examination was negative for malignancy. Although serum and pleural fluid CA19-9 levels were elevated, imaging showed no findings suggestive of malignancy. We diagnosed the patient with CA19-9 producing splenic cysts and performed laparoscopic decapsulation.
In the Hybrid operating room, a balloon catheter was positioned in the splenic artery. Four ports were inserted into the abdomen; the cyst was punctured and intracystic fluid was suctioned out. Combined splenic artery balloon occlusion was performed to control bleeding when the cyst wall was resected near the splenic parenchyma, using the Thunderbeat TM. Occlusion was performed to create intermittent blockage consisting of 20 minutes of ischemia and 5 minutes of reperfusion; this was repeated twice. Then, the inner surface of the cyst wall was cauterized using the VIO soft-coagulation system TM. Total operation time was 170 minutes (laparoscopic time, 110 minutes) and blood loss was 100 grams.
There were no intra- or post-operative complications and the patient was discharged on the sixth post-operative day. Histological findings revealed that the lesion was a benign true epidermoid cyst, and immunostaining analyses showed that the epithelium was positive for CA19-9 antibody. The patient’s serum CA19-9 level decreased from 3,437 to 62 U/ml after surgery, and she has remained well with no recurrence for four months.
Conclusions: Laparoscopic decapsulation for treatment of splenic cysts can prevent life-threatening bacterial infections by preserving the spleen, while increasing the risk of bleeding from the left splenic parenchyma. Combining splenic artery occlusion with laparoscopic decapsulation is a safe and feasible approach in the Hybrid operating room.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77859
Program Number: P170
Presentation Session: Poster (Non CME)
Presentation Type: Poster
