SPLENIC CYSTS
They are alterations of the spleen that can lead to bleeding and infections; can be divided into three types:
Congenital cysts: cysts present in the organ from birth, do not have a well-defined cause and are asymptomatic
- Pseudocysts: These are similar to cysts but do not have a well-defined wall and are usually caused by trauma to the spleen with "self-contained" bleeding near the organ.
- Echinococcus cysts: they are caused by a parasite that is acquired by eating food contaminated with the feces of farm animals or, more rarely, domestic animals with this parasitosis; They are the most dangerous since they can become superinfected, they can bleed and even rupture (a very dangerous situation that can cause anaphylactic shock due to the release of the parasites contained in the cyst into the body).
Splenic cysts are usually asymptomatic, however they can cause various symptoms, from a simple "mass effect" (splenomegaly compresses the other abdominal organs, causing a sensation of heaviness and/or pain) to infection and bleeding.
Diagnosis is often made incidentally by follow-up abdominal ultrasound for another cause or by pain or a feeling of heaviness on the left side . Computed tomography (CT) and magnetic resonance imaging (MRI) can also help in the diagnosis.
In the case of Echinococcus cysts, the differential diagnosis with a simple cyst (congenital or pseudocyst) can be facilitated by the search for anti-Echinococcus antibodies which, if positive in the presence of a cyst in the spleen, suggest a cyst due to Echinococcus. to this parasite.
The treatment of the splenic cyst depends on its cause. For congenital cysts and pseudocysts, treatment can be 1) conservative and, in these cases, you can only check the behavior of the cyst over time to see if it increases in size or symptoms appear (so-called follow-up) or you can proceed to alcoholization by puncturing the cyst, under radiological control, aspirating its liquid content (which will later be analyzed) and then injecting an alcoholic solution that causes an inflammatory reaction, hardening the cyst walls and "petrifying" them; 2) interventionist: in these cases, in the presence of symptoms and/or complications, surgery is performed with total or partial removal of the spleen called splenectomy. In the case of an Echinococcus cyst, before surgery, it is necessary to carry out a home antiparasitic treatment with a drug, albendazole, for at least 1 week, to prevent anaphylactic shock that could occur in case of rupture (before or during surgery). ) of the cyst itself. The antibiotic treatment will be continued for at least 1 month after the operation, while, if it is decided not to operate, it should be carried out for a minimum of 3 months at the maximum dose.
Although partial splenectomy still has some indications, it is currently in disuse due to its greater intraoperative and postoperative risk (bleeding), in favor of total splenectomy, an operation that by itself does not cause changes in the patient's lifestyle; however, given the immune function of the spleen, especially against infections by encapsulated bacteria, vaccination against Streptococcus Pneumoniae, Haemophilus Influenzae, and Neisseria Meningitidis is strongly recommended within two weeks after surgery.
BENIGN HEMATOLOGICAL DISEASES
They are benign conditions due to alterations of the blood cells, such as hemolytic anemia, thrombocytopenic purpura and hypersplenism. These pathologies often manifest from childhood with bone malformations, generalized vascular thrombosis and hemorrhage, frequently associated with respiratory and gastrointestinal tract infections, fever and malabsorption.
The diagnosis is clinical-laboratory and is based on the evaluation of the blood smear and the complete blood count.
The treatment in some of these pathologies (including the use of blood transfusions) serves mainly to treat the symptoms and reduce their frequency; only in some cases drug therapy is enough to completely resolve the picture. For this, total splenectomy is indicated in many of these pathologies due to the hemocateresis function of the spleen; by removing the organ, in fact, the elimination of blood cells is reduced and the alterations responsible for the symptoms are eliminated.
INFECTIOUS DISEASES AND ABSCESSES
The spleen can be the site of abscesses and primary infections, rare and due to sepsis and immunosuppression; or secondary, due to microorganisms that can also colonize the spleen through the blood, especially if there are bruises or cysts.
The most frequent infection responsible for splenomegaly worldwide is malaria, but, in our latitudes, it is by far mononucleosis. However, there are many other causes of infected splenomegaly; Bacteria, viruses, fungi, and parasites can complete part of their life cycle inside the spleen.
The diagnosis is clinical-laboratory and is based on the presence of symptoms (variable depending on the infection) and on the identification of the responsible microorganism or the antibodies formed as a response of the immune system.
Radiology can confirm splenomegaly, usually with a simple abdominal ultrasound. Computed tomography (CT) and magnetic resonance imaging (MRI) can help identify more complex or extensive multiple abscesses and thus plan surgery.
Treatment depends on the pathogen; however, in some cases splenectomy may be indicated to reduce the mass effect in the other abdominal organs responsible for worsening symptoms.
SPLENIC INFARCTION AND ANEURYSM OF THE SPLENIC ARTERY
The spleen, like other organs, can suffer an infarct due to occlusion of the arterial vessels that feed it secondary to embolism, compression, pancreatitis, and neoplastic splenomegaly.
The incidence of this condition is much lower than that affecting other organs, such as the heart or the brain, and the clinical relevance varies from paucisymptomatic forms to acute abdominal symptoms characterized by pain in the hypochondrium/left flank, fever, and splenomegaly. Asymptomatic cases, however, can have a high mortality if the splenic infarction is accompanied by a subsequent infarction of other organs (which is not uncommon).
Early diagnosis, performed by abdominal ultrasound, is essential to avoid potentially fatal consequences and to intervene in the best possible way.
If medical treatment with anticoagulants fails to resolve the condition, surgical removal should be used.
Another pathological condition, even rarer than heart attack, but potentially responsible for the same dangerous consequences, is splenic artery aneurysm.
An aneurysm is the pathological dilation of a part of the wall of an arterial vessel; This dilation, in addition to being able to cause compression on other organs and structures (causing variable symptoms), makes the vessel much more fragile and prone to spontaneous bleeding, which can cause intra-abdominal hemorrhage.
The cause of a splenic artery aneurysm is related to arteriosclerosis, congenital hypoplasia (ie, the presence of a spleen that is smaller than normal and less functional from birth), trauma, or chronic inflammation.
Produces epigastric pain or splenomegaly. It can rupture or create arteriovenous fistulas (abnormal communications between nearby arteries and veins that cause potentially lethal circulatory disturbances).
The diagnosis is usually made through an abdominal ultrasound, but sometimes it may be necessary to request a CT or MRI, to accurately plan the necessary surgery.
Treatment consists of removal of the spleen with resection of the aneurysm and, if necessary, resection of the pancreatic tail (given the close relationship of the spleen to the terminal part of the pancreas and their shared vascular supply).
TRAUMATIC INJURIES
The spleen, like other organs, can suffer traumatisms that can be unique or be part of polytraumatisms in several abdominal organs. The trauma can also vary in intensity and can involve a simple laceration or complete rupture of the organ.
The symptoms, in these cases, depend on the severity of the lesions but, in general, the symptoms, although they vary in intensity, are the same: abdominal pain (especially in the hypochondrium and left flank), hemoperitoneum (that is, bleeding in the interior of the peritoneum, the "sac" that contains the abdominal organs), and hypovolemic shock (hypotension, tachycardia, paleness, sweating, and oliguria).
The diagnosis is made in the emergency room and an abdominal ultrasound is usually sufficient to identify the bleeding, its origin and its extension. Second level examinations, CT and MRI, can give more precise indications, especially before surgery, whenever possible.
The treatment in all these cases is surgical ; Although conservative treatment can be attempted in minor trauma, in most cases total splenectomy is performed.
CONGENITAL ABNORMALITIES
The spleen, like other organs, can be malformed from birth. These are divided into abnormalities of shape (such as the lobulated spleen), position (the ptotic spleen), or number (the accessory spleen). Also, the spleen may not even be present, a condition known as asplenia.
These abnormalities are usually not symptomatic, however, especially in positional abnormalities such as ptotic spleen (a spleen that is in a different position than normal, usually lower on the left side), abdominal pain may occur. due to compression of the spleen on the other abdominal organs, or it can lead to torsion of the vascular axis of the organ and its ischemia.
The diagnosis in these cases is usually incidental through an abdominal ultrasound performed for control or for other reasons.
In case of absence of symptoms, there is no need for any treatment; in case of symptoms, however, splenectomy is indicated.
BENIGN NEOPLASMS
The spleen can harbor, like other organs, benign tumors. These take different names depending on the tissue from which they originate: hemangioma, which originates as a proliferation and malformation of blood vessels, lymphangioma, which originates from lymphatic vessels, and hamartoma, which originates as a consequence of tissue proliferation. embryonic cells that abnormally remain inside the organ.
These lesions usually present in childhood and are mostly asymptomatic; however, they can grow rapidly and cause compressive symptoms in other organs, abdominal pain, and can also cause rupture of the spleen (even after minor trauma). Also, in very rare cases, some of these tumors, such as lymphangioma, may have a malignant course.
The diagnosis, as for congenital anomalies of the spleen, is incidental (if the lesion is asymptomatic) or (in the presence of symptoms) as a result of a clinical-instrumental evaluation. Abdominal ultrasound represents, as in all pathologies of the spleen, the first-line investigation.
The optimal treatment, the gold standard, is, as always, splenectomy.