A cute eight-year-old girl.  She notice’s that she has had intermittent abdominal pain for the last 1 year and shows the upper left side.  They thought it was stomach, gas pain so no one really cared. A huge cyst is seen on the upper side of her spleen in the abdominal ultrasonography requested by the pediatrician after her complaints continued.  After making the necessary examinations, making sure that it is not caused by parasites and eliminating other malignant diseases, we perform laparoscopic surgery and remove the upper half of the spleen.  We send her home after a day or two.
 
In the Pediatric Surgeon’s Journal, I explained splenic cysts in children.
  
Pediatric Surgery is a very strange specialization.  We are like the old general surgeons.  We operate on every part of the child’s body.  That’s why the topics I told you about cover a very wide range.
 
The requests that come to me through social media are naturally related to common problems.  But sometimes there are requests for topics related to rare cases.  When rare cases are mentioned, our strange branch comes to mind.  We can encounter all kinds of unusual anomalies.  Here is the case of non-parasitic splenic cyst, which I described in the introduction.  We, pediatric surgeons, see this disease, which is stated to be seen in the general population at a rate of seven per ten thousand, at a higher rate perhaps because our number is also low.
 
Now, before I tell you about splenic cysts, let me give you some information about the spleen.
 
The spleen, you know, is an organ just to the left behind the stomach.  It plays an extremely important role in regulating the immune system.  It produces antibodies, ensures that some bacteria are removed from the body.  It filters the blood by removing the aged, deteriorated cells.  It stores some blood cells.  It performs the necessary tasks in the production of lymphocytes and in the regulation of the volume of the plasma.  Since it has a soft and fragile structure and fulfills such important functions for the body, the stomach is protected by the ribs behind it.  If even our own nature is this protective, of course, it knows something.  In this case, we also need to protect.  Therefore, instead of removing the entire spleen, we prefer spleen-preserving treatments such as removing the diseased half.
 
When we say cyst, naturally we do not operate on every cyst.  For example, pseudocysts formed due to reasons such as injury, infection, vascular occlusion are actually the most common types of cysts in the spleen.  They constitute almost 80% of all splenic cysts.  Parasitic cysts, which we call hydatid cysts, are responsible for up to 10% of splenic cysts.  In this type of cyst, it may be necessary to use medical treatment or other surgical methods.  The patient we mentioned in the introduction had a rare, non-parasitic real cyst of the spleen. 
 
The primary true splenic cysts that I mentioned are mostly seen in children, and they are usually detected by accidental ultrasonography or other imaging methods, since they do not cause any complaints.  If it does not cause a complaint and its diameter is less than five centimeters, and we are sure that it is a simple cyst radiologically, we do not touch it at all, we follow it.  However, if it causes symptoms such as feeling of fullness, vomiting, abdominal pain due to pressure on neighboring organs, or if it is large enough to cause problems such as perforation, infection and bleeding, we do operate.
 
If we are going to do splenic surgery, we want to preserve the spleen as much as possible.  I have just told you how important its duties are.  If we have to completely remove the spleen, we have to vaccinate against some bacteria for life.  Since we know this, if the location of the cyst is suitable, we remove the diseased half of the spleen with the laparoscopic method.  Thus, the remaining spleen continues to perform its duties, and with the advantage of the laparoscopic method, we discharge quickly without leaving any scars.  If this is not suitable for surgery, we try to destroy the cyst with other surgical techniques and interventional radiology.  The aim is to eliminate the pathology, protect the spleen and discharge our patient as early as possible.
 
When it comes to discharge, let me give you a short non-medical information.  Especially in our War of Independence, everyone who had a gun was fighting under the leadership of Mustafa Kemal Atatürk to save our homeland.  Those who were sick and injured were treated in hospitals or public health facilities, and those who recovered were sent back to their battalions.  About to fight again.  Did you know that the phrase “to be discharged” in Turkish is “to send battalions” ?  I got goosebumps.
 
We’ve come to the end of another journey.  Please click if you want to watch this talk, and to follow me on Instagram.
 
 And stay happy.
 
Prof.  Dr. Egemen EROGLU
April 2022