A New Approach to the Treatment of Large Splenic Cysts: Transgastric Puncture and De-epithelialization under Endosonographic Guidance

Introduction. Splenic cysts are rare benign neoplasms, occurring at a frequency of approximately 0.75 per 100,000 population per year. These lesions are significantly less common compared to cystic neoplasms of other organs such as the liver, pancreas, and kidneys, accounting for less than 1% of all cystic lesions of internal organs. In most cases, splenic cysts are asymptomatic and are discovered incidentally during instrumental examinations. For a long time, surgical treatment of patients with splenic cysts involved open or laparoscopic resection of the spleen, as well as splenectomy. However, in recent years, minimally invasive approaches to the treatment of patients with splenic cysts have been increasingly considered in clinical practice, particularly ultrasound-guided cyst drainage followed by sclerotherapy of the cyst wall for de-epithelialization. Clinical observation. A 20-year-old female patient underwent surgical treatment at the Endoscopic Surgery Department of the Vishnevsky National Medical Research Center of Surgery for a nonparasitic splenic cyst located in the hilum of the spleen, measuring approximately 6 cm. Results. In our clinical case of treating a patient with a large splenic cyst, we successfully performed a minimally invasive procedure consisting of intraluminal transgastric puncture and de-epithelialization of the splenic cyst under endosonographic guidance. Conclusion. Endoscopic intraluminal transgastric puncture with subsequent de-epithelialization of the splenic cyst under endosonographic guidance is an optimal minimally invasive technique and a preferable alternative to traditional surgical interventions.