Spleen cyst treatment: what to do, how to remove it?

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

Medicines

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

Anthelmintic drugs can 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 a minimum of three courses of therapy. Albendazole is taken in an amount of 10 mg per kilogram of body 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 with fatty foods to increase bioavailability. The courses are carried out sequentially, maintaining an interval of 2 weeks between approaches. Albendazole is considered a practically safe drug, and, nevertheless, some side effects are possible - in particular, bone marrow suppression. Tablets are used with caution to treat patients with severe hepatic pathologies: liver function should be monitored and changes in the cellular composition of the blood should be monitored (every 14 days). When leukopenia appears, the treatment course is suspended until the indicators return to normal.

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. With multiple echinococcosis, treatment is adjusted individually.

Physiotherapy treatment

Physiotherapy is prescribed mainly at the stage of the patient's 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, on the age and general condition of the patient. Against the background of rehabilitation treatment, the following physiotherapy procedures can be used:

• magnetotherapy;
• electrophoresis;
• ultrasound, laser treatment, etc.

Sessions are allowed to be carried out already in the first days after the operation, since this enhances the effectiveness of drug methods, reduces the risk of complications, and shortens the recovery period. Early physical therapy practice allows you to:

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

Additionally, patients are prescribed physiotherapy exercises, individual sessions with a psychologist, exercises for household adaptation, reflexology.

Herbal treatment

Alternative methods of treatment really help at an early stage of the development of a spleen cyst, or during the rehabilitation period after removal of the neoplasm. Consider the most common and effective recipes using available medicinal plants.

• Take 20 g of saponaria bark, 20 g of oak bark and 1 liter of water. The whole bark is crushed, poured with water, put on fire. Bring to a boil and boil for five minutes. Next, remove from heat and insist under a lid until it cools, filtered. Take three times a day, 100 ml, washed down with the same amount of warm boiled water. The duration of the treatment course is one month.
• Prepare an infusion of hop cones, 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 the lid. The remedy is taken in 30 ml daily before each meal (30-35 minutes), for several weeks.
• Prepare herbal collection, consisting of equal parts of nettle leaves, string herb, violet flowers, strawberry leaves. Boiling water (0.5 l) pour 20 g of the prepared mixture, cover with a lid and wrap well. Withstand at least one hour, filtered. Take an infusion of 250 ml three times a day, between meals.
• Prepare a tincture of kopeck herb using 50 g of plant materials and 0.5 liters of vodka. The crushed raw materials are poured with vodka, insisted in a darkened place for three weeks, filtered. Take 10 ml of tincture daily before each meal.
• Children can prepare an aqueous infusion of penny herb, based on the calculation of 10 g of a plant per 0.5 liters of boiling water. The agent is taken 50 ml before each meal (about 4 times a day).

In addition, alternative healers advise adding raisins to the diet. It is optimal to eat it in the morning on an empty stomach in an amount of 50 g (soak it in water at room temperature in advance in the evening, eat it with water). The minimum course of treatment is one month.

Surgery

Removal of the spleen cyst is prescribed in such cases:

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

Currently, operations are performed mainly by the laparoscopic method, removing part or all of the organ (which is determined individually). Open surgery, which involves the traditional incision of the peritoneum from the xiphoid process to the umbilical foramen, is being performed less and less.

Laparoscopy of the spleen cyst can consist in the following manipulations:

• puncture of the cystic capsule with further administration of a sclerosing agent;
• removal of the neoplasm with its membranes, with the processing of the inner lining;
• partial partial resection of an organ with a cyst;
• complete removal of the organ - splenectomy, followed by autotransplantation of splenic tissues into the greater omentum.

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

A laparoscope is a device with a miniature camera and illumination. It allows the surgeon to make very small incisions (punctures) in the abdominal wall, and at the same time perfectly see the area of 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 a patient's hospital stay after laparoscopic splenectomy is no more than a week. Already after 24 hours the patient is allowed to stand up and eat liquid food. Overall, recovery lasts about two weeks. After discharge, registration with a hematologist and immunologist is mandatory. [3]

With a small size of the spleen cyst, puncture of the neoplasm is possible. Puncture of the spleen cyst is performed under the control of an ultrasound diagnostic apparatus with further intracavitary administration of a sclerosing substance. This manipulation allows you to remove single uncomplicated formations of small diameter (up to 30-50 mm), localized subcapsularly at the surface of the diaphragm. The introduction of a sclerosing agent ensures the prevention of subsequent recurrence of the pathology. [4]

Fenestration of the spleen 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 the immediate vicinity of the splenic surface, then removal is performed by autopsy with treatment of the inner part with argon-enhanced plasma. If there are vessels next to the wall, then hemostatics are used at the same time. [6]

If there is no possibility of a separate removal of the neoplasm, then they resort to total splenectomy, followed by autotransplantation of organ tissue into the greater omentum to preserve immunological functionality.

After surgical treatment, patients are advised to follow up with a hematologist and surgeon for a long time. During the first few months after the intervention (2-3 months), physical activity should be limited. Further, patients should undergo an ultrasound follow-up examination every six months for 2-3 years after splenectomy. [7]

Spleen cyst diet

Special principles of nutrition will help to reduce the load on the damaged spleen, and at the same time make up for the lack of vitamins and minerals in the body, which is necessary to prevent the development of adverse consequences. It should be said right away that the immune system "does not like" overeating, too hot or cold food, rough foods, excess sweets.

But what products must be included in the diet of a patient with a spleen cyst:

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

The following should be excluded from the diet:

• animal fats, lard;
• fried, too salty and spicy foods;
• alcoholic drinks;
• chemical enhancers of taste and smell, flavorings, seasonings.

It is undesirable to use pickled and smoked products, coffee, strong black tea.

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