Epithelial (epidermoid) splenic cysts in childhood: surgical management of eight cases.

We report eight cases of splenic epithelial cysts in childhood to summarize our clinical experience and to discuss surgical management. Six boys and two girls, aged 8 to 14 years (mean 10.8 years) were diagnosed over a 16-year period. No patients had a history of preceding trauma or related infection. Presenting symptoms were dull (two) or acute (one) left hypochondrium pain and diffuse abdominal pain (one). In four children the cyst was an incidental finding. Ultrasound and/or CT revealed cysts of diameter 2.9 to 14 cm and radionuclide scan showed a reduced uptake in the splenic area of concern. At operation variable amounts--up to 1500 mL--of liquid were aspirated from the cysts. Splenic artery ligation was undertaken in six cases adjunctively to cystectomy. One total splenectomy was performed because the splenic parenchyma was totally replaced by the cyst. Recurrence occurred in one case, in which multiple tiny communicating cysts were detected. Histology revealed epithelial (n = 5) or stratified squamous (n = 3) lining. Five patients were seen again 0.5 to 5 years later and they were asymptomatic and with a normal ultrasound, CT, or radionuclide scan. Cyst excision was an effective treatment. Adjunctive splenic artery ligation when performed controlled hemorrhage. Other surgical methods to manage splenic cysts are discussed.