Splenic Hamartoma Diagnosed and Treated by Laparoscopic Splenectomy Associated With a Minimal Suprapubic Approach

BACKGROUND Splenic tumors are rare and challenging to diagnose, and laparoscopic splenectomy (LS) is useful for treatment. Splenic hamartoma is a rare benign condition that consists of disorganized normal splenic tissue, including red pulp elements, that can be asymptomatic and found incidentally. CASE REPORT A 42-year-old woman underwent ultrasonography, and a 70×55 mm splenic mass was detected. The tumor was composed of a solid component and a cystic lesion, and splenomegaly was observed (size: 143 mm). Contrast-enhanced computed tomography (CT) of the solid component clearly showed homogeneous and strong enhancement in the early phase. The estimated splenic volume was 650.7 mL. Magnetic resonance imaging did not indicate malignancy. A preoperative diagnosis of splenic hamartoma was made, and LS was performed. To control intraoperative bleeding and to shrink the spleen, the splenic artery was ligated first. The spleen was caught in the containment bag, and a 50 mm transverse skin incision was made cranially at the pubic bone. The stump of the splenic vein was cut within the bag, and 30 mL of blood was removed to further shrink the spleen. Next, the extremely shrunken spleen (201 g) was removed through the small abdominal incision. Histopathologically, disorganized normal splenic tissue, including red pulp elements, were observed. The patient was discharged on postoperative day 4, and rehabilitation was accomplished by postoperative day 7. No postoperative complications were observed. CONCLUSIONS This report highlights the rare condition of splenic hamartoma, and described the key techniques for advantageous LS.