Splenic hydatid cyst: is splenectomy necessary?

Abstract

The spleen is a rare location for hydatid cysts with the larvae reaching the site after escaping the hepatic and pulmonary filters. For most surgeons, splenectomy is the primary treatment in such cases which aims at eradicating the disease while decreasing the chances of recurrence by removing the intact cyst. While this is true, the risks of other two parasitic infections are increased, namely malaria and babesiosis. In the case presented here, the spleen was preserved after extirpating the cyst to keep the patient's immunity against malaria, which is endemic in our region. KeywordsSplenectomy, hydatid cyst, immune function * Corresponding author: ezzedien@hotmail.com Canines are the definitive hosts of the tapeworm Echinococcus granulosus. Humans are accidental intermediate hosts by consuming food or water contaminated by the eggs of the parasite. In the small intestine the eggs hatch and the released larvae penetrate the intestinal wall to gain access to the circulation and reside in different organs, primarily the liver, forming cysts. The disease is endemic in sheep and cattle rearing countries in both the developed and developing world (Bauman 2004).A 30-year-old female presented with pain in the left hypochondrium. On examination, she looked generally well; the vital signs were within normal and chest and heart examination showed no abnormality. The abdomen was soft with a palpable mobile mass in the left upper quadrant and bowel sounds were normal. Apart from a slightly raised white cell count (10.7 cell/cubic mm) there was no biochemical or haematological abnormalities.An ultrasound (US) and computerized axial tomography (CT) scan of the abdomen showed a large cystic lesion, 10 × 15 cm, occupying the upper half of the spleen with the characteristic appearance of hydatid cyst (Figs 1 and 2). The liver and kidneys were normal and no other lesions were detected. The diagnosis was splenic hydatid cyst and the patient was prepared for surgery.On call to surgery, intravenous Augmentin (amoxicillin and clavulanic acid) was given. Hydrocortisone was also given at the start of the operation and the abdomen was entered through a left subcostal incision. There were dense adhesions between the enlarged spleen and the anterior abdominal wall. At the medial aspect of the spleen, there was a fluctuant area marking the cyst. After isolation of the area with abdominal packs, aspiration and re-injection of the cyst cavity with 0.5% silver nitrate solution was done twice. The cyst was then opened and evacuated of the laminated membrane and all debris or membrane remnants were thoroughly removed (Fig. 3). A drain was inserted in the cyst cavity and the abdomen was closed.Oral feeding was started in the first postoperative day and the diet was gradually built up. The drain was removed on the fifth day when the drainage fluid became nil, and the patient was discharged on the 7th post-operative day.During her outpatient follow up three months later, she remained in good health and the cavity previously occupied by ...

Simultaneous Huge Splenic and Mesenteric Hydatid Cyst

“…Localization of the hydatid cyst in the spleen is rare, especially when the spleen is the primary and single organ affected by the infection of the parasite Echinococcus. This occurs in about 2% of cases of cystic echinococcosis and occurs when the parasite avoids hepatic and pulmonary filters [6][7][8].…”

Spontaneous rupture of malarial spleen: report of two cases

“…In our previous work, we questioned the advisability of splenectomy for patients residing in malaria endemic areas, who contract splenic hydatid disease 13. The rationale behind that is the importance of the immune functions of the spleen in the fight against malaria.…”

“…In our previous work, we questioned the advisability of splenectomy for patients residing in malaria endemic areas, who contract splenic hydatid disease. 13 The rationale behind that is the importance of the immune functions of the spleen in the fight against malaria. Compared to normal individuals, asplenic patients living in malaria-endemic areas are more commonly parasitaemic, and have delayed clearance of the parasite after treatment.…”

A case of giant primary splenic hydatid cyst: Case report

“…Hydatid disease can develop in any organ, but the liver (60–70%) followed by the lung (30%) are the most frequent sites as they act as filters to the larvae in their journey in the blood stream [ 3 , 6 ]. Most of the larvae are trapped in the liver (first Lemman's filter) to form hepatic hydatid cysts; some larvae evade the hepatic microvascular barrier to reach the lungs (second Lemman's filter) forming pulmonary hydatid cysts and a small fraction of the released larvae bypass both filters and are distributed to different organs including the spleen, kidney, peritoneum, brain, bone, thyroid and mesentery [ 3 , 6 , 7 ]. Splenic echinococcosis may also arise by retrograde spread from the liver to the spleen via the hepatic portal and splenic veins in portal hypertension and the spleen can also be affected by rupture of a hepatic echinococcal cyst into the peritoneal cavity [ 7 ].…”