Giant solitary hydatid cyst of spleen—A case report

M.M. Pukar^⁎ and Shabari M. Pukar

1. Introduction

Hydatid disease (Echinococcosis) is a zoonotic infection caused by the larval form of parasites of tapeworm, Echinococcus granulosus. Humans are the accidental intermediate host in the development cycle of hydatid disease. It is an endemic disease in the sheep and cattle raising countries Middle East, North Africa, New Zealand, Australia, and South America.

1.1. Case presentation

A 28 years female patient farmer by occupation presented to our general surgery clinic with a mass in the left upper quadrant of the abdomen. There was left hypochondriac dull aching pain which did not shift or radiate. The size of lump increased rapidly over past 6 months. Patient complained of malaise with nausea, vomiting and weight loss since one year. Also there was intermittent fever every fifteen days since last six months. She had no history of jaundice, cough or respiratory distress, abdominal trauma, weight loss and her past medical history was unremarkable. On examination, her vital parameters were within normal limits. Physical examination showed an asymmetric abdomen and a growing lump with smooth surface in left hypochondriac, epigastric and umbilical region. Mild epigastric tenderness was noted with no rebound tenderness, guarding, or hepatomegaly. There was no lymphadenopathy. Chest, cardiovascular, central nervous, and the musculoskeletal systems were normal on examination.

Routine laboratory investigation CBC, coagulation profile, biochemistry, renal function test, liver function test and electrolytes revealed no abnormalities. ESR was of 75 mm/h (Westergren). Plain radiograph of the abdomen revealed a well-defined, rounded soft-tissue opacity with calcified margins in the left hypochondrium. Chest radiograph was normal. Abdominal ultrasonography showed round, well defined, cystic lesion of approx., size 165 × 140 mm over pancreas which moving left kidney and spleen.

Abdominal CT scan shows large homogenous cystic lesion in spleen measuring 20 × 22 cm loculated cyst with many septa, originating from the spleen. The cyst in the spleen appeared to fill the left quadrant of the abdominal cavity, displacing the intestines to the right, most likely suggestive of hydatid cyst. There were no cysts in other abdominal viscera. A CT scan of his chest did not show any cysts. Laparotomy was performed through a midline incision. Surgical exploration revealed a hydatid cyst occupying whole splenic parenchyma only thin rim of splenic tissue was present in inferior surface. The mass measuring approximately 250 × 200 mm was attached to left diaphragm. The cyst was resected en-bloc with the spleen. The rest of the abdominal organs including the liver were normal. In order to treat any potential contamination, the abdomen was washed locally with hypertonic saline solution (NaCl 20%). Histopathological examination showed the classic laminated cyst wall encircling many scolices with a double layer of hooklets; which is consistent with Echinococcus granulosus infection thus confirmed the diagnosis of splenic hydatid cyst. On cut section there was hydatid sand and fluid around 3.9 litres. The postoperative period was uneventful and the patient was discharged on the postoperative day 7. The postoperative course was uneventful with three additional weeks of albendazole treatment. The clinical and ultrasonography follow-up did not show any evidence of recurrence at six months (Figs. 1–3).

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