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case_images: Computed tomography showing a giant splenic cyst.
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case_images: An ultrasound scan showed a large splenic cyst with no increase in vascularity on Doppler assessment, while an intravenous contrast-enhanced CT scan showed a 12.5 x 9.7 x 10.7 cm well-defined cystic mass arising from the upper pole of the spleen (Fig. 1) with multiple fine echogenic shadows and medial displacement of the stomach and the left kidney (Fig. 2).
case_images: A schematic illustration of the ports positions. The working ports are numbered 1 and 3, port 2 is for the laparoscope, while port 4 is for a 5-mm diamondflex retractor.
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case_images: Laparoscopic surgery proceeded with four ports in the left upper abdomen (Fig. 3).
case_images: An operative image showing the splenic hilum slung with the vascular tape and clamped with a segment of a nasogastric tube.
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case_images: The slung splenic hilum was clamped by advancing a plastic tube (a mid-section of a nasogastric tube) over the Nylon sling and fixing it in position with a haemostat applied outside the abdomen (Fig. 4). The cyst was then decompressed by aspirating its clear straw-coloured fluid content which enhanced exposure and access.
case_images: An operative image showing the splenic cyst after de-capsulation with a bloodless bed and minimal bleeding from edges of the cyst.
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case_images: The hilum was unclamped after a total ischaemia time of 30 min and no bleeding was encountered despite reducing the intraperitoneal pressure to 7 mmHg for 3 min. The spleen appeared well perfused (Fig. 5). 