This protocol addresses benign splenic tumor presenting as a non-parasitic splenic cyst with negative hydatidosis serology that is either larger than 5 cm or causing symptoms — the threshold at which intervention is warranted.

Clinical Scenario

The patient has a splenic cyst confirmed to be non-parasitic (negative hydatidosis serology). The cyst exceeds 5 cm or is symptomatic. At this size, non-operative management is generally not sufficient: the increased risk of rupture, infection, bleeding, chemical peritonitis, and abscess formation guides the decision toward operative treatment.

Treatment Approach

The recommended management involves a surgical procedure targeting the cyst, with an emphasis on preserving splenic tissue wherever feasible. The operative strategy differs depending on cyst location and characteristics. The complete decision algorithm — including which approach applies in each circumstance — is available in the full protocol.

References

DOI: 10.1016/j.soda.2024.100127

In our algorithm, we recommend partial splenectomy for splenic cysts larger than 5 cm or symptomatic cysts.
If negative, although there is no evidence-based cut-off limit for the non-operative versus operative treatment, a non-operative management is generally accepted if the cyst is < 5 cm in size and surgery is recommended if it is > 5 cm, because of the increased risk of rupture or infection associated with bleeding, chemical peritonitis, and abscess formation.
When possible, splenectomy must be partial to preserve splenic parenchyma and avoid long-term complications (mainly infections and portal system thrombosis).
Marsupialization can be recommended for superficial splenic cysts, as it is safe and effective.

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Treatment of Benign Splenic Tumor in Non-Parasitic Splenic Cyst Larger Than 5 cm or Symptomatic

Clinical Scenario

Treatment Approach

References