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Spleen is an important organ in humans with numerous complex functions, most notably immunity. Surgical pathologies of the
spleen such as tuberculosis (TB), cyst, and hemangioma are very rare. A high index of suspicion is required for diagnosis and
treatment. A retrospective analysis of four young patients was done. Their clinical manifestations were nonspecific and varied,
most common being vague abdominal pain and splenomegaly. The first patient had a large recurrent splenic epithelial cyst.
Initially, treated by a laparoscopic fenestration procedure but recurred within 8 months. Second was a Littoral cell angioma.
Third, TB of the spleen and the last was a ruptured pseudocyst. Blood investigations were normal; thrombocytopenia was
observed with the splenic cyst due to sequestration or destruction. Diagnosis was by imaging with ultrasound and contrast
enhanced computer tomography. Patients underwent a laparoscopy or open splenectomy. Distal pancreatectomy was combined
in the pseudocyst case. All recovered well following surgery. To conclude, this case series provides a varied and nonspecific
presentation of splenic pathologies. In suspected cases, imaging is very crucial for diagnosis. Most often, such rare pathology
of the spleen need splenectomy for diagnoses or definitive treatment.
Key words: Spleen, Tuberculosis, Cyst, Hemangioma, Splenectomy