J. J. Lopez1,2, D. Lodwick1,2, J. Cooper2, M. Hogan3, D. King1, P. Minneci1,2 1Nationwide Children’s Hospital,Pediatric Surgery,Columbus, OHIO, USA 2Nationwide Children’s Hospital,Center For Surgical Outcomes Research,Columbus, OHIO, USA 3Nationwide Children’s Hospital,Pediatric Radiology,Columbus, OHIO, USA
Introduction: Non-parasitic splenic cysts, both true cysts and pseudocysts, are the most commonly seen type of splenic cyst seen in children in Western countries. Sclerotherapy (ST) is a newer and less invasive procedure to treat splenic cysts than splenectomy. However, there are no large studies examining the long-term efficacy of ST.
Methods: We performed a retrospective chart review and prospective follow-up imaging study of pediatric patients treated for non-parasitic splenic cysts at our institution during 2006-2015. Patients were identified using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 289.59 and 759.0. Included patients were also required to have had either a procedure order for “IR Body Sclerotherapy” or a partial splenic operation (partial splenectomy, cyst excision, or marsupialization). Charts were reviewed for patient presentation, demographics, radiographic findings, number and types of ST treatments or operative interventions, and complications. For the prospective study, all patients successfully contacted were asked to return for ultrasonography to evaluate for resolution/recurrence of the splenic cyst. Success of therapy was defined as decrease in the size of the cyst or complete ablation on follow-up imaging.
Results: Eight patients who underwent surgical intervention and nineteen patients who underwent ST were identified. Patients underwent a median of 4 ST treatments. The overall initial success rate for ST was 89.5% (17/19). Of the 2 ST patients without complete resolution of their cyst, one patient had ST with sotradecol/ethanol for 8 treatments, then returned to the ED with fever and underwent total splenectomy. The other patient failed to show improvement with ST and underwent partial splenectomy. Twelve patients have been contacted and agreed to undergo follow-up ultrasound. In the first 5 patients (4 patients treated with ST and 1 treated with partial splenectomy), 1 former ST patient was found to have a return of a small asymptomatic cyst on imaging. The other 4 patients remain cyst-free on follow-up imaging. Prospective imaging in all patients will be complete by 12/2016.
Conclusions: Pediatric patients with non-parasitic splenic cysts may benefit from treatment with ST, but should expect that it will require multiple treatments. Prospective evaluation of the durability of splenic cyst ST as compared to partial splenic surgery is needed and is ongoing.