Treatment of spleen cysts: what to do, how to remove?

In most cases, the cyst is removed using a minimally invasive laparoscopic method. Recovery after such an operation is faster and more comfortable for the patient. [ 1 ]

If the cyst is located in the spleen hilum, or is simply very large, then in such cases the possibility of preserving the organ is lost. It is optimal for such patients to undergo splenectomy with autotransplantation of their own splenic tissue into the greater omentum: this helps to preserve the immunological capacity of the organ.

Medicines

In the vast majority of cases, surgical treatment (splenectomy, puncture drainage) is used for splenic cysts of various etiologies. Drug therapy is only supportive and symptomatic. In case of parasitic neoplasms, postoperative antihelminthic therapy is mandatory. As conservative methods for echinococcosis, drugs from the benzimidazole series (Albendazole, Mebendazole) are used. There is information on the success of using Praziquantel in combination with benzimidazoles in patients with tissue contamination during surgery or with cystic rupture.

Anthelmintic drugs can also be prescribed for inoperable echinococcosis - for example, in the presence of technical difficulties, multiple lesions, etc. Such treatment is absolutely contraindicated in case of individual hypersensitivity and in the first trimester of pregnancy.

Experts recommend at least three courses of therapy. Albendazole is taken in the amount of 10 mg per kilogram of weight per day in two doses: in the morning and in the evening with an interval of 12 hours, for 28 days. The tablets should be taken together with fatty foods to increase bioavailability. The courses are carried out sequentially, with an interval of 2 weeks between approaches. Albendazole is considered a virtually safe drug, and, nevertheless, some side effects are possible - in particular, suppression of bone marrow function. The tablets are used with caution to treat patients with severe liver pathologies: liver function should be monitored and changes in the cellular composition of the blood should be monitored (every 14 days). If leukopenia appears, the treatment course is suspended until the indicators are normalized.

The severity of side effects is reduced by taking hepatoprotectors (Antral, Gepabene, Hofitol), antihistamines (Diazolin, Allertek).

Mebendazole is taken in a daily dosage of 40-50 mg/kg for up to six months. In case of multiple echinococcosis, treatment is adjusted individually.

Physiotherapy treatment

Physiotherapy is prescribed mainly at the stage of patient recovery after surgery. Certain procedures help relieve pain, accelerate tissue regeneration, improve blood circulation in the operated area, maintain muscle tone, and prevent the development of postoperative complications.

The duration of the rehabilitation period depends on the scale of the intervention, the age and general condition of the patient. The following physiotherapy procedures can be used during rehabilitation treatment:

• magnetic therapy;
• electrophoresis;
• ultrasound, laser treatment, etc.

Sessions are allowed to be held already in the first days after the operation, since this increases the effectiveness of drug methods, reduces the risk of complications, and shortens the recovery period. Early practice of physiotherapy allows:

• quickly relieve swelling of damaged tissues;
• prevent the processes of fibrosis and hyalinosis during scar formation;
• activate phagocytosis in the wound area;
• accelerate the restoration of tissue structure.

Additionally, patients are prescribed therapeutic exercise, individual sessions with a psychologist, exercises for everyday adaptation, and reflexology.

Herbal treatment

Traditional methods of treatment really help at the early stage of development of a spleen cyst, or during the rehabilitation period after removal of the neoplasm. Let's consider the most common and effective recipes that involve the use of available medicinal plants.

• Take 20 g of soapwort bark, 20 g of oak bark and 1 liter of water. Grind all the bark, add water and put on the fire. Bring to a boil and boil for five minutes. Then remove from heat and leave under a lid until cool, filter. Take 100 ml three times a day, washing down with the same amount of warm boiled water. The duration of the treatment course is one month.
• An infusion of hop cones is prepared based on the proportion of 10 g of cones per 200 ml of boiling water. The infusion must be kept for about 8-9 hours under a lid. The remedy is taken 30 ml daily before each meal (30-35 minutes), for several weeks.
• Prepare a herbal infusion consisting of equal parts of nettle leaves, string grass, violet flowers, and strawberry leaves. Pour boiling water (0.5 l) over 20 g of the prepared mixture, cover with a lid and wrap well. Leave for at least an hour, filter. Take the infusion 250 ml three times a day, between meals.
• Prepare a tincture of the herb of the kopeck grass, using 50 g of plant material and 0.5 l of vodka. The crushed raw material is poured with vodka, infused in a dark place for three weeks, filtered. Take 10 ml of tincture daily before each meal.
• For children, you can prepare a water infusion of the herb of the kopeck grass, based on the calculation of 10 g of the plant per 0.5 l of boiling water. The remedy is taken 50 ml before each meal (about 4 times a day).

In addition, traditional healers advise adding raisins to the diet. It is best to eat 50 g of them in the morning on an empty stomach (soak them in room temperature water the night before and eat them with water). The minimum course of treatment is one month.

Surgical treatment

Removal of a spleen cyst is prescribed in the following cases:

• in the presence of absolute indications, such as suppuration, rupture, internal bleeding;
• in conditionally absolute indications, if the detected cyst is more than 100 mm in diameter, or if there are intense symptoms in the form of constant pain syndrome, severe digestive disorders, cachexia, etc.;
• in relative indications, if the cystic neoplasm has a diameter of about 30-100 mm, or if conservative treatment does not bring the desired effect, as well as in case of relapses of the spleen cyst.

Currently, operations are performed mainly laparoscopically, removing part or all of the organ (which is determined individually). Open surgery, which involves a traditional incision in the peritoneum from the xiphoid process to the umbilical opening, is performed less and less frequently.

Laparoscopy of a splenic cyst may involve the following manipulations:

• puncture of the cystic capsule with subsequent introduction of a sclerosing agent;
• removal of the neoplasm with its membranes, with treatment of the inner lining;
• partial resection of an organ with a cyst;
• complete removal of the organ – splenectomy, followed by autotransplantation of splenic tissue into the greater omentum.

Splenectomy is one of the difficult operations that must be performed by a qualified and experienced surgeon using high-quality laparoscopic equipment. For uncomplicated cysts of small size (50-100 mm, single or multiple) and non-parasitic etiology, laparoscopic access is practiced. [ 2 ]

A laparoscope is a device with a miniature camera and lighting. It allows the surgeon to make very small incisions (punctures) in the abdominal wall, and at the same time to clearly see the area of the operation and perform manipulations. After such an intervention, postoperative recovery is faster and more comfortable, and the risk of complications is significantly reduced. The duration of the patient's stay in the hospital after laparoscopic splenectomy is no more than a week. After 24 hours, the patient is allowed to get up and eat liquid food. In general, recovery lasts about two weeks. After discharge, it is mandatory to register with a hematologist and immunologist. [ 3 ]

In case of small splenic cysts, it is possible to perform a puncture of the neoplasm. Puncture of the splenic cyst is performed under the control of an ultrasound diagnostic apparatus with subsequent intracavitary introduction of a sclerosing agent. Such manipulation allows for the removal of single simple formations of small diameter (up to 30-50 mm), localized subcapsularly at the surface of the diaphragm. Introduction of a sclerosing agent ensures the prevention of subsequent relapse of the pathology. [ 4 ]

Fenestration of the splenic cyst – excision of the capsular walls – is performed within healthy tissues, which is necessary to maintain the functional state of the organ. [ 5 ] When a single formation is found in close proximity to the splenic surface, removal is performed by opening with treatment of the internal part with argon-enhanced plasma. If there are vessels near the wall, hemostatics are used simultaneously. [ 6 ]

If it is not possible to remove the neoplasm separately, then they resort to total splenectomy with subsequent autotransplantation of organ tissue into the greater omentum to preserve immunological functionality.

After surgery, patients are recommended to have long-term follow-up with a hematologist and surgeon. Physical activity should be limited for the first few months after the procedure (2-3 months). Then, patients should undergo ultrasound follow-up examinations every six months for 2-3 years after splenectomy. [ 7 ]

Diet for spleen cyst

Special nutrition principles will help reduce the load on the damaged spleen, and at the same time replenish the body's lack of vitamins and microelements, which is necessary to prevent the development of adverse effects. It should be said right away that the immune system "does not like" overeating, too hot or cold food, coarse products, and an excess of sweets.

Here are some foods that should definitely be included in the diet of a patient with a spleen cyst:

• sea fish, moderate fat content, boiled, stewed, baked;
• boiled beets, in salads and soups;
• cabbage (if there are no problems with the digestive system);
• avocado, pomegranate, green apples;
• nuts (in moderation);
• buckwheat and oatmeal porridge;
• honey and other bee products;
• cranberries and other sour berries.

The following should be excluded from the diet:

• animal fats, lard;
• fried, overly salty and spicy foods;
• alcoholic beverages;
• chemical flavor and aroma enhancers, flavor additives, seasonings.

It is not advisable to consume pickled and smoked foods, coffee, and strong black tea.

Preference should be given to vegetable soups, porridges, lean meat and fish, and stewed vegetables.