Giant isolated hydatid cyst of spleen

Liver is most commonly involved organ in hydatid cyst. Primary splenic hydatid cysts are rare; we report a case of an isolated giant hydatid cyst of spleen in a 17-year-old man. The diagnosis was confirmed by imaging findings and serology. Partial cystectomy was performed with success. In cystic lesions of spleen, hydatid cyst should be kept in patrician’s mind in the differential diagnosis. Although splenectomy is the gold standard for treating hydatid disease of the spleen, in young patient spleen-preserving surgery seems give good results. DOI : COMING SOON Running title: Giant HCS Keys words: spleen-preserving surgery, splenectomy, hydatid cyst, spleen Corresponding Author: Mehdi Soufi, MD, Division of digestive and oncological Surgery, Oujda CHU, faculty of medicine. University Mohammed first Bp 4847 Oujda université 60049, Oujda Morocco (Tel: +212661212924; Email: drsoufimehdi@hotmail.fr) Freely Available Online www.openaccesspub.org | JSLR CC-license DOI : coming soon Vol-1 Issue 1 Pg. no.8 Introduction: Hydatid disease is a helminthic anthropozoonosis with worldwide distribution that is caused by the larval stage of Echinococcus granulosus [1]. Liver and Lungs are the most common sites of involvement in adults. Echinococcal cysts are mostly found in the liver and lungs but the disease can occur almost anywhere in the body [1]. Usually, splenic involvement in hydatid cysts follows systemic dissemination or intra peritoneal spread following ruptured hepatic hydatid cyst. Primary hydatid disease of the spleen is very rare even in endemic areas [2]. We report a case of an isolated giant hydatid cyst of spleen of a 17-yearold man. Treated successfully by a spleen-preserving surgery.


Introduction:
Hydatid disease is a helminthic anthropozoonosis with worldwide distribution that is caused by the larval stage of Echinococcus granulosus [1]. Liver and Lungs are the most common sites of involvement in adults.
Echinococcal cysts are mostly found in the liver and lungs but the disease can occur almost anywhere in the body [1]. Usually, splenic involvement in hydatid cysts follows systemic dissemination or intra peritoneal spread following ruptured hepatic hydatid cyst. Primary hydatid disease of the spleen is very rare even in endemic areas [2]. We report a case of an isolated giant hydatid cyst of spleen of a 17-yearold man. Treated successfully by a spleen-preserving surgery.   Mediterranean region [1]. The liver is the most frequent location of parasitic cysts but Hydatid disease can occur almost anywhere in the body [2,3]. Primary hydatid cyst of spleen is extremely rare, with an incidence of 2 to 3%, even in the endemic regions [4].

Case report:
In our case, only isolated splenic disease was found without pulmonary, hepatic, and any other tissue involvement. When the eggs of parasite escape the liver-lung barrier (15%) they can cause a primary infestation wherever in the body through the arterial route [4,5].
Patients with splenic hydatid cyst are usually asymptomatic or had non-specific symptoms [4]. The most common finding is incidentally discovered splenomegaly [5]. pseudocyst may be a diagnostic dilemma [5,12]. CT may show the cystic lesion with or without daughter cysts within the spleen with an attenuation value near that of water without any contrast enhancement [10,11].
Hematological examination may reveal eosinophilia.
Immunoelectrophoresis, enzyme-linked immunosorbent assay (ELISA), latex agglutination, and indirect haemagglutination test are helpful for the diagnosis [13]. A negative serology does not rule out cystic echinococcosis . In these cases the diagnosis can be difficult . Although the sensitivity of serological testing is not clearly dependent on the extent of disease, it does appear to be dependent on cyst stage. [14].
echinococcal IgG ELISA test has perhaps the highest positive predictive value among the available serological tests, but unfortunately may only have a negative predictive value of <90% [14]. A rapid immunochromatography test kit using the recombinant Em18 antigen was recently developed. It seems be simple, reliable, and easy-to-use [15].
Laparoscopic approach has also been described for uncomplicated hydatid cyst of the spleen [18]. In our case the cyst was attached to diaphragm, tail of the pancreas and retroperitoneum, we performed a partial cystectomy without any dissection of other organs. In the literature, there is no significant difference in recurrence rates between splenectomy and spleensparing surgery [16].
The presence of multiple splenic cysts or communication between the spleen and nearby organs total splenectomy must be preferred [17]. In young patient splenectomy may have a several complication (10%) such as hemorrhage, pancreatic or gastric injuries, thromboembolic phenomena and post splenectomy infection, in these case some surgeons prefer conservative surgery [16].
We think that in huge cyst of spleen especially in young patient total splenectomy including organ involvement may be dangerous for a benign lesion. Albendazole is an effective adjuvant therapy in the treatment of hydatid cyst. it decreases the viability of cysts at the time of surgery and significantly reduces the chances of cyst recurrence [19]. The chemotherapy is indicated in patients who are at high risk for surgery, after spillage during surgery and as a concomitant therapy with percutaneous drainage [19].

Conclusion
Primary hydatid cyst of spleen is rare. It is still difficult to differentiate between parasitic and non-parasitic splenic cysts. Combination of CT scan remains the most sensitive investigations for diagnosis. This case suggests that Hydatid disease should be considered as a differential diagnosis in every patient with a cystic mass of the Spleen. If mortality and morbidity rates are very low, total splenectomy may be the treatment of choice in adults, but in children spleen-preserving surgery should be considered to prevent complications.
Competing interest: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.