Epithelial cyst arising in an intrapancreatic accessory spleen: a case report of robotic surgery and review of minimally invasive treatment

Abstract

Background An epithelial cyst in an intrapancreatic accessory spleen (ECIPAS) is rare. We report a case of ECIPAS that was treated with robot-assisted distal pancreatectomy with splenectomy. Case presentation The case was a 59-year-old woman who was referred to our hospital after a pancreatic tail tumor was found on computed tomography prior to surgery for small bowel obstruction at another hospital. A cystic lesion in the pancreatic tail was discovered and evaluated by magnetic resonance imaging and endoscopic ultrasonography. Based on clinical and radiological features, mucinous cystic neoplasm was included in the differential diagnosis. The patient underwent robot-assisted distal pancreatectomy with splenectomy. The postoperative course was uneventful. Pathological evaluation revealed a 20-mm ECIPAS in the pancreatic tail. Conclusions If a pancreatic tail tumor is present, ECIPAS should be included in the differential diagnosis. However, preoperative diagnosis is difficult, and a definitive diagnosis is often not obtained until after surgery. Surgery should be minimally invasive. Laparoscopic distal pancreatectomy has become a standard surgical procedure because it is minimally invasive. Robot-assisted surgery is not only minimally invasive, but also advantageous, because it has a stereoscopic magnifying effect and allows the forceps to move smoothly. Robot-assisted distal pancreatectomy may be a good option, when performing surgery for a pancreatic tail tumor.

Cavernous hemangioma of an intrapancreatic accessory spleen mimicking a pancreatic tumor: A case report

“…However, cystic neoplasm development in IPASs is rare. Sporadic cases of epidermoid cysts in IPASs (known as ECIPASs) have been reported[ 6 , 9 - 11 ]. The walls of ECIPASs are irregularly thickened and thicker than those of mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs)[ 9 ].…”

Giant epidermoid splenic cyst associated with elevated serum marker CA 19‐9

“…As known, the spleen is an organ that has an important role in the immune system, blood storage, and blood filtration, so total splenectomy may show a higher incidence of thrombocytosis and increase the risk of infection caused by encapsulated organisms 5 which brings us to the point that the choice of splenic preservation is reasonable since partial splenectomy is feasible, especially for younger patients with the advent of the laparoscopic approach 5,12 . Some selective case has been operated on with the approach of robotic surgery 13 . In some cases, the surgeons have no better option than a total splenectomy, when small parenchyma has remained or splenic vessels are involved in the cyst wall making the splenic preservation difficult 12,14 …”

“…5,12 Some selective case has been operated on with the approach of robotic surgery. 13 In some cases, the surgeons have no better option than a total splenectomy, when small parenchyma has remained or splenic vessels are involved in the cyst wall making the splenic preservation difficult. 12,14 Other various alternative approaches have been described, aiming at avoiding splenic tissue when conventional surgery is not possible.…”

Accessory Spleen: A Rare and Incidental Finding in the Stomach Wall

“…An accessory spleen occurs when splenic tissue is in a separate body region, which occurs in up to 15% of the population [ 1 ]. The most common locations for accessory spleens are in the splenic hilum (80%) and the pancreatic tail (17%) [ 2 - 5 ]. However, they can also be located within the greater omentum and gastrointestinal tract [ 2 ].…”