Hydatid Cyst of the Spleen: Tunisian Series of 21 Cases

Abstract

Hydatid disease is a parasitic infection caused by Echinococcus granulosus. Splenic involvement is rare even in endemic areas. The aim of this study is to specify epidemiologic features, diagnostic tools, and therapeutic modalities of this uncommon entity. This is a retrospective study of 21 patients operated on for a splenic hydatid cyst between January 1996 and December 2011. The mean age was 43.8 years (range 15-72 years). Sixteen patients (76.2 %) had symptoms related to a splenic location of hydatid disease. While splenic hydatid disease was solitary in 8 patients (38.1 %), other locations were present in 13 patients (61.9 %), mainly in the liver. Most splenic cysts were type I (39.3 %) or III (42.8 %). Nine patients (42.8 %) underwent resection of the protruding dome with one postoperative complication (suppuration of residual cavity). Total and partial splenectomies were performed in nine and three patients, respectively, without any complication. No death was noted. After a mean follow-up period of 36 months (range 2-108 months), no recurrence was observed. Splenic hydatid cyst is a rare location. The diagnostic is usually easy, based on serology and imaging. The surgery is the mainstay of treatment. The type of surgical procedure depends on size, number, and location of the cyst. Total splenectomy is more effective but may have high morbidity and mortality and must be reserved to specific situations. Conservative procedure is safer but could increase the rate of recurrence and postoperative collection. Puncture aspiration injection reaspiration could be proposed for small cyst in inoperable patients.

Spleen hydatidosis treated by hemi-splenectomy: A low-morbidity, cost-effective management by a recently improved surgical technique

“…Although the theoretical indications to partial splenectomy are numerous, hereditary spherocytosis (mainly in children) represents the main indication to partial splenectomy within the current literature [5,21], followed by benign cysts [8,17,22] and trauma [7,8]. In the case of benign cystic disease, cystectomy is also proposed with good results and low morbidity [23,24], although it is rarely reported for hydatidosis [23].…”

Surgical Approach to Splenic Hydatid Cyst: Single Center Experience

“…1,2 Currently, estimates of the worldwide incidence of this disease range from 0.5 to 8.0%, accounting for 0.5 to 4.0% of all abdominal echinococcosis cases reported. [1][2][3]7,9,12 However, these studies have failed to definitely determine whether primary or secondary cases are more common (with wide ranges of incidence rates being reported; primary: 38.1-80.0%, secondary: 16.0-61.9%), [1][2][3]5,[8][9][10]12 or whether solitary or multiple lesions are more common (solitary: 41.1-94.7%, multiple: 5.3-33.0%). 1,2,4,6,[8][9][10] It is possible that these disease characteristics are affected by yet unknown geographic, behavioral, environmental, or other many factors.…”

“…Key words: Spleen -Splenic hydatid cyst -Splenectomy -Clinical experience -Diagnosis -Outcome H ydatid disease, also known as echinococcosis, is caused by the Echinococcus parasites belonging to the Taeniidae family of the Cestode class. [1][2][3][4][5][6][7][8][9][10][11][12] While 4 of these parasitic species are known human pathogens, the most commonly diagnosed are E. granulosus, which causes cystic echinococcosis (known as hydatid cysts) and E. alveolaris, which causes alveolar echinococcosis. 1 However, humans are considered incidental hosts of the parasites, and infection is established upon oral ingestion of materials contaminated with fecal matter containing Echinococcus eggs from the primary hosts (dogs and other canids) or direct contact with dogs.…”

“…Endemic areas currently include the Middle East, Far East, Mediterranean, South America, Australia, and Turkey. 1,3,9,13 Epidemiological profiling has shown that the primary organs affected by Echinococcus colonization (and subsequent cyst formation) are the liver (50-77%) and lung (15-47%), with cases of colonization in the kidney (2-4%) being reported rarely. 1,2,6,7 Development of splenic hydatid cyst (SHC) is considered especially rare, with some estimates of incidence being as low as 0.5% of all cases.…”

“…1,2,6,7 Development of splenic hydatid cyst (SHC) is considered especially rare, with some estimates of incidence being as low as 0.5% of all cases. [1][2][3][4]9,12 SHC cases are classified as either primary (involving the spleen only) or secondary (with multiple organ involvement). In general, hydatid cysts grow very slowly, so that patients remain asymptomatic (and undiagnosed) for years.…”