Laparoscopic cystectomy with unroofing for a giant splenic epidermoid cyst in a child: a case report
Mohsen Noei, Arash Dadvand, Negin Haghshenas, Mirsalim Seyedsadeghi, Atabak Sedigh-NaminIntroduction and importance:
Splenic epidermoid cysts are rare congenital lesions that are most frequently diagnosed in children. The rarity of this condition and the lack of standardized guidelines highlight the importance of reporting such cases.
Case presentation:
A 13-year-old boy presented with progressive left shoulder pain, epigastric fullness, early satiety, and abdominal distension. Contrast-enhanced CT revealed a 145 × 122 mm hypodense cyst within the splenic parenchyma with smooth margins and no septations or calcifications. Hydatid serology was negative. The patient underwent successful laparoscopic cystectomy with unroofing and spleen preservation (operative time: 70 minutes, blood loss: 10–20 mL). Histopathology confirmed a benign splenic epidermoid cyst. Postoperative recovery was uneventful, and the patient remained symptom-free with no recurrence at 1-year follow-up.
Clinical discussion:
Splenic epidermoid cysts are thought to arise from embryonic mesothelial cell entrapment. Symptoms are size-dependent and may include referred shoulder pain (Kehr’s sign). In regions endemic for hydatid disease, serological exclusion of echinococcosis is essential. Spleen-preserving procedures are preferred in children to maintain immune function and reduce the risk of overwhelming post-splenectomy infection.
Conclusion:
Laparoscopic cystectomy with unroofing is a safe, minimally invasive, and spleen-preserving option for giant symptomatic epidermoid cysts in children. Preoperative exclusion of hydatid disease in endemic regions and long-term imaging surveillance are recommended.