Splenic cyst

　　1. Parasitic cyst

　　1. Parasitic cysts are formed by hydatid cysts of Echinococcus granulosus, which develop and grow into parasitic cysts in the spleen through the blood of larvae, with no lining epithelium in the inner wall of the cyst, containing parasitic worms or eggs and necrotic tissue inside. There may be splenic hydatid cysts, often coexisting with liver and lung echinococcosis, and are found in northern pastoral areas of China.

　　2. Non-parasitic cysts include true and false cysts

　　(1) True cyst Including epidermoid cysts, dermoid cysts, vascular and lymphatic cysts, etc., which differ from pseudocysts in that the inner wall of the cyst is covered with flat, cuboidal, or columnar epithelium. Among them, epidermoid cysts are more common in young people and are often solitary.

　　(2) Pseudocyst True cysts are more common, accounting for about 80% of non-parasitic cysts, most of which are unilocular, may have a history of trauma, and the cysts can be very large, with the cyst wall without endothelial cell covering.

　　1. Cyst rupture:The rupture of ovarian chocolate cysts usually occurs during the luteal phase or menstrual period, mainly manifested as sudden onset of persistent lower abdominal severe pain, but without abnormal vaginal bleeding. The pain usually starts from one side and then spreads to the entire lower abdomen, and its severity is often more than that caused by other gynecological acute abdominal diseases, and often accompanied by muscle tension, rebound pain, and other peritoneal stimulation signs, but the occurrence of shock is extremely rare;

　　2. Hemorrhage;

　　3. Secondary infection;

　　4. Acute peritonitis:Acute peritonitis (acute peritonitis) is a common surgical acute abdominal disease, whose pathological basis is the stimulation or damage of the parietal layer and (or) the visceral layer of the peritoneum due to various reasons, causing an acute inflammatory reaction. It is usually caused by bacterial infection, chemical stimulation, or physical injury. Most cases are secondary peritonitis, originating from the infection of abdominal organs, necrosis and perforation, trauma, etc.;

　　5. Granulomatous inflammation:The main cell components of granuloma are epithelioid cells and multinucleated giant cells. In these pathological processes of chronic granulomatous inflammation, under the long-term stimulation of undigested bacteria or other antigenic substances, an excessive number of macrophages entering the focus are transformed into epithelioid cells, surrounding the focus, and there are scattered multinucleated giant cells among the epithelioid cells.

　　Parasitic splenic cysts are more common in middle-aged and young adults, while non-parasitic splenic cysts are more common in adolescents; small cysts may not have clinical symptoms and are often found during physical examination with ultrasound. However, when large cysts compress and stimulate adjacent organs, they may present with symptoms of organ compression, most commonly with discomfort or hidden pain in the upper left abdomen, and sometimes it can also involve the umbilical area or radiate to the right shoulder and left lumbar back. If it compresses the gastrointestinal tract, it may cause bloating, indigestion, constipation, and other symptoms. Complications of splenic cysts include cyst rupture, hemorrhage, and secondary infection, with symptoms and signs of peritonitis in patients.

　　Most patients with splenic dermoid cysts have no clinical symptoms and are often discovered incidentally during health check-ups or other disease examinations. A few patients may find abdominal masses during visits, which are tense to the touch, may have pain, have slight elasticity, can move, and can also shift during inhalation. Ultrasound, CT, or selective splenic artery angiography can all assist in diagnosis more accurately, but sometimes laparotomy is needed to confirm the diagnosis.

　　Splenic cysts are tumor-like cystic lesions of splenic tissue. Clinically, they can be divided into parasitic cysts and non-parasitic cysts. Parasitic splenic cysts are common in middle-aged and young adults, while non-parasitic splenic cysts are more common in adolescents. Small cysts may not have clinical symptoms and are often found during physical examination with ultrasound. However, when large cysts compress and stimulate adjacent organs, they may present with symptoms of organ compression, most commonly with discomfort or hidden pain in the upper left abdomen. Sometimes, it can also involve the umbilical area or radiate to the right shoulder and left lumbar back. If it compresses the gastrointestinal tract, it may cause bloating, indigestion, constipation, and other symptoms.

　　Since some patients' onset is closely related to parasitic infections, it is necessary to avoid parasitic infections during prevention. If parasitic infection has occurred, active treatment should be carried out.

　　1. Laboratory examination

　　The proportion of eosinophils in blood routine is significantly increased. The Casoni intradermal test (Casoni skin sensitivity test) shows a positive reaction.

　　2. Other auxiliary examinations

　　Ultrasound is often used as the first choice for the examination of splenic cysts, while CT and MRI can further understand the shape, size, number, characteristics of the cyst cavity and cyst wall, and the relationship with surrounding organs. For extremely rare splenic cysts such as splenic dermoid cysts (teratoma), endothelial or mesothelial cysts, etc., angiography can assist in diagnosis.

　　1. Foods that should be avoided for patients with splenic cysts: Avoid greasy, cold, and difficult-to-digest刺激性 foods.

　　2. It is recommended to consume more foods rich in vitamins, such as fresh fruits and vegetables, which not only provide the body with the necessary nutrition but also assist in anti-tumor and anti-cancer effects, thereby ensuring that liver cysts remain in a non-cancerous state.

　　3. Try to eat lighter and use (Baijiu Xiaofang prescription) to gradually nourish for a while. Pay attention not to eat salty foods (including preserved foods), spicy and irritating foods (including chili, alcohol, shrimp, crabs, etc.), contaminated foods (including rotten and deteriorated foods, leftover meals, etc.), and barbecued foods. Those with incomplete renal function or who have developed uremia should also pay attention not to eat legumes and their products, limit high-protein animal foods, and greasy foods.

　　4. Water Intake: Due to different causes, course, and treatment measures of various kidney diseases, they are not the same. In mild renal failure, due to the decline in renal concentrating function, more water is needed to excrete metabolic products from the kidneys. Therefore, for kidney diseases without obvious edema, heart failure, or hypertension, water restriction should not be blind. A special reminder is that patients with chronic renal failure should not think that renal failure requires strict water restriction. Overly strict water restriction may actually worsen renal function deterioration.

　　5. It is advisable to eat a diet low in fat, high in protein, high in vitamins, and easy to digest. Be regular, quantitative, and moderate. In the early stage, it is recommended to eat more soy products, fruits, fresh vegetables, and appropriate amounts of carbohydrates, eggs, fish, and lean meat; when liver function significantly decreases and there are signs of hepatic coma, it is necessary to control protein intake appropriately and advocate a low-sodium diet or salt-free diet.

　　Due to the gradual enlargement of splenic cysts, which can easily rupture and endanger life when they reach a certain size, it is generally believed that surgical treatment should be performed for any type of splenic cyst in principle. In the past, total splenectomy was the only choice for the treatment of splenic cysts. In recent years, considering the importance of preserving the spleen for the body's immune function, in addition to cysts being infectious or located in the hilum area, it is generally advocated to perform partial splenectomy or cystectomy. This surgical method is especially significant for pediatric patients. If the spleen is heavily adherent to surrounding tissues and the cyst is unilocular and complicated with purulent infection, splenic cyst puncture and drainage can be applied; for unilocular splenic cysts of huge volume, the contents can be aspirated first before splenectomy; for purulent and echinococcal cysts, attention should also be paid to surrounding organs during surgery to prevent the spread of infection. In recent years, with the development of laparoscopic technology, laparoscopic splenectomy, splenic cystectomy, and splenic cyst fenestration have also become important choices for the treatment of splenic cysts.