Page 44 - World Journal of Laparoscopic Surgery

CASE REPORT
Single-port Splenectomy after Splenic Cyst Aspiration for

Huge Splenic Cyst with High CA 19-9 Levels: The State of

the Art

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Borja Camacho Fernández-Pacheco , Eudaldo López-Tomassetti Fernández , David Fernández-San Millán ,
Juan Ramón Hernández Hernández 4
AbstrAct
Aim: Description of a patient with an elevation of CA 19-9 levels caused by a giant benign splenic cyst, which was completely laparoscopically
resected through a single port, despite the large size of the lesion. An increase in CA 19-9 in this type of cystic tumors does not indicate malignancy.
Background: The cystic tumors of the spleen are rare diseases that may present a CA 19-9 increase, without indicating malignancy. There is a
tendency to perform surgical intervention as less invasive and aggressive as possible. The current trend in the management of splenic cysts
with a CA 19-9 increase and benign radiological characteristics, is a minimally invasive surgery, whenever possible.
Case description: We present a case of a young patient with a giant splenic cyst of 20.5 × 14.5 × 23 cm and elevated CA 19-9 levels. Spleen
was completely laparoscopically resected through a single port after the cyst puncture and aspiration, using the advantages of laparoscopic
surgery and single port. Had a favorably postoperative course with resolution of the symptoms up to the current date.
Conclusion: There is an actual tendency to perform minimally invasive surgical interventions. In pathologies such as the clinical case provided, we
should try to make a surgical intervention as less invasive as possible, despite the large size of the lesion. In our case, we successfully performed the
resection of a giant splenic cyst, using the advantages of laparoscopic surgery and the single port, which helped us in the extraction of the piece.
Clinical significance: When facing this pathology, we must bear in mind that benign epithelial and mesothelial cysts can produce an increase
of CA 19-9 blood levels, without indicating malignancy. So, we should try to make a surgical intervention as less invasive as possible.
Keywords: CA 19-9, Laparoscopy, Mesothelial cyst, Single-port, Splenic cyst.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1379

bAckground 1–4 Department of Gastrointestinal Surgery, Complejo Hospitalario
Splenic cystic tumors are rare diseases, with an estimated incidence Universitario Insular-Materno Infantil Las Palmas de Gran Canaria,
of 0.07%. Benign epidermoid and mesothelial cysts may present Spain
a CA 19-9 increase, without indicating malignancy, which is why Corresponding Author: Borja Camacho Fernández-Pacheco,
they usually cause the clinician to be confused. We present a case Department of Gastrointestinal Surgery, Complejo Hospitalario
of a young patient with a giant splenic cyst and elevate CA 19-9, Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria,
which was completely laparoscopically resected through a single Spain, Phone: +34 626367126, e-mail: bcamachofp@hotmail.com
port after the cyst puncture and aspiration. How to cite this article: Camacho Fernández-Pacheco B, López-
Tomassetti Fernández E, Fernández-San Millán D, et al. Single-port
Splenectomy after Splenic Cyst Aspiration for Huge Splenic Cyst with High

cAse description CA 19-9 Levels: The State of the Art. World J Lap Surg 2019;12(3):130–132.
Source of support: Nil

A healthy 19-year-old woman with no personal history of interest
presented pain in the left hypochondrium of 2 months of evolution Conflict of interest: None
accompanied by dyspepsia, anorexia, and weight loss. On physical
examination, a palpable mobile mass was observed. Abdominal CT was locked, and pneumoperitoneum performed. The pericystic
(Fig. 1) showed a splenic cyst of 20.5 × 14.5 × 23 cm with a marked adhesions were released with the help of the ultracision (Fig. 2B)
mass effect towards the stomach without infiltration of adjacent and subsequent section of short vessels. The vessels of the splenic
organs. Blood analyses were normal, without portal hypertension hilum were sectioned with endoGIA (Covidien, USA) 60 mm vascular
or hypersplenism data, but CA 19-9 blood level of 2,496 U/mL was load (Fig. 2A), and the piece was extracted through the single port.
highlighted. Definitive pathological anatomy of the surgical specimen was
Because of the patient’s symptoms, a laparoscopic splenectomy a benign epidermoid cyst (Fig. 3). The cytology of the cyst content
was performed through a single transumbilical port, extending was negative for malignancy.
the incision to the supraumbilical midline about 3 cm. As the first After the surgical intervention, the patient progressed
step, the umbilical trocar ring was introduced, and a controlled favorably, with resolution of the symptoms up to the current date.
aspiration of the cyst content was made prior to splenectomy. After Analysis performed after the intervention showed normalization
aspiration and cyst collapse, the hermetic seal of the single trocar of CA 19-9 levels.

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