A Review of the Treatment of Splenic Cysts at Children's Medical Center

INTRODUCTION: The management of non-parasitic splenic cysts in children is unclear. Options include partial or total splenectomy and rarely percutaneous aspiration and sclerotherapy. The aim of this study is to assess the outcomes of these interventions. METHODS: Retrospective review of patients <18 years with splenic cysts (2009-2016) at a major children's hospital was performed after IRB approval. Demographics, mode of intervention and outcome data were collected. Due to the small numbers, statistical analysis was limited. RESULTS: 42 patients were identified and initial management was as follows: 32 observation alone, 10 underwent intervention (4 aspiration and sclerotherapy, 6 resection). Age (yrs) was higher for intervention than observation (p=0.004). Incidental finding was the most common presentation for patients that were observed (n=30; 100%, p<0.001) and abdominal pain for intervention groups: aspiration and sclerotherapy (n=3; 75%, p=0.16), resection (n=5; 83%, p=0.05). Cyst size (cm) was larger for intervention than observation (p<0.001). Follow up was available for 20 of the 32 observed children, 18 requiring no intervention. 2 patients failed observation and required aspiration and sclerotherapy, one at 5 months and one at 3.5yrs due to persistence of symptoms and size increase, respectively. Of the 6 children who underwent aspiration and sclerotherapy; 2 patients underwent 1 round of sclerotherapy, 2 had multiple planned rounds and 2 required multiple additional unplanned rounds of sclerotherapy. 2 patients failed sclerotherapy and underwent resection. For the 8 children who underwent resection, procedures included open splenectomy (n=2), laparoscopic partial (n=2), or complete splenectomy (n=1) and laparoscopic cystectomy (n=3). Cysts were histologically identified as epithelial (n=4), mesothelial (n=2), pseudocyst (n=1), and unknown (n=1). One small recurrence was noted in 5 of 8 patients who followed up. Based on the number of cases, statistical significance could not be computed for recurrence rate. However, aspiration and sclerotherapy required more interventions and failed more often than resection patients. CONCLUSIONS: Observation of splenic cysts is an appropriate management strategy for small asymptomatic splenic cysts. Percutaneous aspiration and sclerotherapy is associated with a higher rate of recurrence while surgical resection is associated with lowest recurrence rates and should be considered for patients with large or symptomatic cysts.