Primitive Isolated Hydatid Cyst of the Spleen: Total Splenectomy Versus Spleen Saving Surgical Modalities

Abstract

BackgroundThis study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease.MethodsThis is a descriptive retrospective study carried out over a period of 7 years extended from January 2013 until December 2019 reporting eight cases of isolated primitive splenic localization of hydatid disease. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy.ResultsThe discovery of the pathology was incidental in 50% of cases, while pain in the left upper quadrant of the abdomen and renitent mass in the same quadrant revealed the pathology only in 25% and 12,5% respectively . None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay ( 9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. ConclusionsThe current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures, as the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

A giant isolated primary splenic hydatidosis: A case report

“…For the population in endemic areas, 50–80% of splenic cysts are caused by Echinococcus [ 7 ]. Interestingly, isolated splenic involvement represents only 2.04% of abdominal HC and 0.7% of infected patients [ 8 , 9 ]. This rarity can be explained by the fact that to cause a primary splenic infestation via the arterial route, Echinococcal oncospheres have to pass the hepatic and pulmonary filters.…”

“…This rarity can be explained by the fact that to cause a primary splenic infestation via the arterial route, Echinococcal oncospheres have to pass the hepatic and pulmonary filters. Although retrograde venous route via portal circulation bypassing the liver and lung was reported, this passage is infrequent [ 8 , 10 , 11 ].…”

“…As splenic HC expands slowly with a rate of 0.3 cm–1 cm per year, it is often asymptomatic and detected accidently on physical examination as an abdominal mass in the left hypochondrium (30%). Patients can also present with abdominal pain (25%), discomfort, or compressive symptoms such as dyspepsia, dyspnea, and constipation [ 8 , 11 ].…”