Diagnosis and Treatment of a Primary Splenic Hydatic Cyst: A Case Report

Introduction: Hydatid disease is a parasitic infection caused by Echinococcus granulosis. The spleen is the third most common site of hydatid disease, after the liver and lungs. Splenic hydatid cyst can be either primary or secondary. We report the case of a primary splenic hydatid disease that was treated with a total splenectomy.

Case Report: A 40-year-old Tunisian female, with no medical history, was referred to our general surgery department, due to heaviness-type abdominal pain concerning the left hypochondrium evolving in the last 2 years. Upon examination, we noticed a left upper quadrant tenderness and splenomegaly. Ultrasonography of the abdomen showed a large solid-cystic mass of the spleen measuring 99*90 mm. CT abdomen confirmed a 12 cm cystic mass occupying almost the entire spleen, multivesicular with partial calcification of the membrane. There was no involvement of liver or other organs. Apart from antiparasitic treatment, she was vaccinated two weeks preoperatively. Laparotomy was performed through the left subcostal incision. Surgical exploration revealed a hydatid cyst occupying the lower pole of the spleen adherent to the left kidney. After short gastric vessels were sutured, total splenectomy was performed by ligation of the splenic artery and vein with close attention to not injure the pancreatic tail. Postoperative course was uneventful. She was discharged from hospital on the sixth postoperative day with antibiotic prophylaxis.

Conclusion: Primary splenic hydatid cysts are rare, even in endemic areas, and often present with non-specific symptoms. Surgical management, particularly total splenectomy, is the standard treatment to prevent complications and recurrence.