Primary splenic hydatid cyst treated with laparoscopic spleen preserving surgery: A case report

Abstract

Background: Primary splenic hydatidosis is an uncommon etiology. Total splenectomy has been the treatment of choice, however, spleen preserving surgery has been gaining popularity.

Case report: We present a case of a 52-year-old man who was evaluated for a splenic cyst, found incidentally on CT scan done at another institution. MRI was repeated in our institution along with an indirect hemagglutination test to confirm the diagnosis. Since our patient had a single non-complicated cyst confined to the spleen's lower pole, we decided to opt for laparoscopic cyst unroofing and omentoplasty, a spleen preserving technique.

Discussion: Due to the rarity of splenic hydatidosis, no strict management guidelines are available, and the decision is usually left for the surgeon. Total splenectomy has been considered the standard of care, however, spleen preserving surgical techniques and percutaneous interventions have been suggested as better alternatives. Spleen preserving techniques lead to surgical outcomes comparable to total splenectomy, with the added benefit of preserving the immunological protection provided by the spleen and protecting patients from dramatic complications that might follow total splenectomy, such as overwhelming post-splenectomy infections, which are associated with very high mortality.

Conclusion: Laparoscopic cyst unroofing and omentoplasty is a feasible surgical technique to treat primary splenic hydatidosis while preserving the spleen's immunologic function.

Keywords: Hydatid cyst; Hydatidosis; Laparoscopy; Spleen; Splenectomy; Splenic cyst.

Fig. 1

Axial images of a non-enhanced CT scan of the abdomen showing a large 14.5 cm well defined hypodense cystic mass of spleen with internal thick dense septations.

Fig. 2

Longitudinal grey-scale images of the spleen which show a 14.2 cm anechoic splenic cyst that shows enhanced transmission through, and contains thick echogenic undulating septations.

Fig. 3

(A) and (B) axial and coronal T2 weighted images (T2 single shot fast spin echo SSFSE) of 3 Tesla MRI that show a cystic lesion of the spleen. The cyst appears of high signal intensity with a hypointense rim (pericyst) and intraluminal septations mostly representing the detached membranes. Findings represent the “water lily sign”. (C) Sagittal T1 3D gradient echo fat sat post gadolinium injection images of the splenic cyst during the portal venous phase that show no enhancement of the cyst wall or septa.

Fig. 4

Hydatid cyst membrane as seen during laparoscopy.

Fig. 5

Laminated membranes of a hydatid cyst involving the spleen (H&E stain, enlarged ×40).