Totally Laparoscopic Partial Splenectomy in a Child with Hamartoma

Background: To date laparoscopic surgery plays a key role in the surgical treatment of not only splenic hematologic pathologies but also of solid pathologies such as benign and malignant tumors. Hamartoma is a rare disease, described for the first time by Rokitansky in 1861. Only few cases are described in the literature, and only 20% of these are of pediatric relevance. In children, hamartoma may be associated with other morbid conditions such as sickle cell disease or other hematologic alterations. Material and Methods: In July 2017, a 7-year-old child presented at the pediatric emergency room for lumbar pain and fever. Abdominal ultrasonography showed a single solid lesion of 5.5 × 6.5 cm with rounded morphology, well-defined margins, and occupying the superior two-thirds of the spleen. Magnetic resonance imaging was performed to better investigate the lesion. On evaluation of the age of the patient and the affected spleen portion, we decided to perform a laparoscopic partial splenectomy. Before surgery, the patient underwent chemoembolization of the upper pole of the spleen to minimize intraoperative blood loss. No postoperative complications occurred and the patient was discharged on the fifth postoperative day. Conclusion: The proper integration between radiologists, pediatricians, and surgeons has allowed the correct management of a pediatric patient suffering from a rare disease. Partial laparoscopic splenectomy can be considered a safe, effective, and reproducible treatment in these patients suffering from benign solid disease, safeguarding the hematologic functions of the organ itself.