PMC7876686_01
CT scan of the thorax and abdomen showed an inhomogeneous hypodense large lymphomatous mass (10 x 6 cm) of upper pole of the spleen deformating medial profile and infiltrating gastric fundus and left diaphragm (arrows).
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We performed a contrast enhanced CT scan of thorax and abdomen that demonstrated an inhomogeneous hypodense large lymphomatous mass (10 x 6 cm) of upper pole of the spleen deformating medial profile and infiltrating gastric fundus and left diaphragm (Fig. 1).
a) laparoscopic exploration with evidence of gastrosplenic fistula; b) dissection of hilum of the spleen with identification of splenic artery and vein; c, d) partial sleeve gastrectomy with Echelon Flex  45 mm blue reload.
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The procedure began with detachment of splenocolic ligament and medial access to the hilum of the spleen (Fig. 2).
a) diaphragmatic invasion originating from upper pole of the spleen; b) in-block resection of part of diaphragmatic dome; c) evidence of no iatrogenic lesion of pulmonary parenchyma; d) surgical field at the end of laparoscopic procedure with resected gastric fundus and sutured diaphragmatic dome.
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With surgical dissection from down-to-up we reached diaphragmatic dome that was infiltrated from splenic mass. We performed an in block multivisceral resection of left diaphragmatic dome with no iatrogenic lesion of pulmonary parenchyma (Fig. 3).