Modified pair technique for treatment of hydatid cysts in the spleen

Splenic Localization of Primary Hydatid Cyst in a 27-Year-Old Sportsman Treated by PAIR Technique: Imaging Anatomy Assessment

Introduction:

In this paper, we report our experience with a case of primary hydatid cyst involving only the spleen in a 27-year-old sportsman treated by PAIR technique.

Case Report:

Five years before, a 27-year-old handball player being admitted to our hospital, it was detected the cyst in his spleen which size was 35 x 30 mm in diameter, by abdominal ultrasound during a systematic examination. There was no pain or any other symptoms at that time. Tests on the presence of echinococcus cysts were negative. After a period of 5 years, and regular check-ups, the patient began to feel a dull pain in the left upper quadrant area. The Echinococcus test was again negative. Puncture and aspiration of content was performed and sent to cytological analysis that confirmed the presence of Echinococcus. The CT finding showed the spleen in a normal position, shape, enlarged, 185 mm in longitudinal diameter (splenomegaly), with inhomogeneous parenchyma on the expense of rounded area with hyperdense halo, which did not opacify after contrast, located in the dorsal area of the spleen, 100x98 mm in diameter and which corresponded to the echinococcal cyst in differential diagnosis–clean dense contents (protein / haemorrhagic).

Conclusion:

The reported case is very specific, considering that handball is contact sport, where it is almost impossible to avoid the physical contact between players, which is sometimes even rough. Due to rough contacts, spleen trauma is something we should be very aware about, especially in cases of splenomegaly with hydatid cyst, where the spleen rupture might lead to fatal outcome. According to all this, careful follow up of this patient is necessary.

Percutaneous Treatment of Non-parasitic Splenic Cysts: Long-Term Results for Single- Versus Multiple-Session Treatment

PURPOSE

The aim of this study was to investigate the efficacy and safety of percutaneous sclerotherapy for non-parasitic splenic cysts (NPSCs). The secondary aims were to introduce puncture-aspiration-injection-reaspiration (PAIR) technique in the treatment of NPSCs and to compare multiple- and single-session techniques.

MATERIALS AND METHODS

This retrospective study included 24 (17 females, 7 males) patients, treated between the years 1997 and 2015. Three techniques were used. Group A (n = 8), Group B (n = 6) and Group C (n = 10) were treated by PAIR, single-session catheterization and multiple-session catheterization, respectively. Since both PAIR and single-session catheterization techniques are carried out in a single session, Group A and Group B were evaluated in one group (Group A + B). Group A + B was compared with Group C in terms of patient demographics, the initial volume of the cysts, follow-up periods, complication and hospitalization rates and follow-up results. Recurrence and reduction rates were evaluated for two groups.

RESULTS

Technical success rate was 100%. The mean follow-up period was 68.9 months. Recurrence detected in 7 (29.1%) patients. Final reduction rate was between 40.7 and 100% (median 96.4%) with a significant difference in cyst volume (p < 0.05). There was no significant difference regarding recurrence rates (p = 1) and the final reduction rates (p = 0.51) between the two groups.

CONCLUSION

Percutaneous sclerotherapy is a minimally invasive technique, preserving maximum tissue while effectively treating NPSCs. Single-session sclerotherapy which reduces hospitalization days and increases patient comfort is as effective as multi-session sclerotherapy as the initial procedure. This study supports that single-session sclerotherapy should be a valid treatment option.

Primary Giant Splenic Echinococcal Cyst Treated by Laparoscopy

Cystic echinococcosis (CE) is a zoonosis caused by the larval stage of the dog tapeworm Echinococcus granulosus. Liver and lungs are the most commonly affected organs whereas splenic infection is rarer and its primary involvement occurs in less than 2% of abdominal CE. We report a case of primary giant splenic hydatid cyst in a 75-year-old Peruvian woman that was laparoscopically removed without any complications, perioperative prophylactic chemotherapy with albendazole 400 mg twice a day 5 days before, and 7 days after the surgical procedure was administered, postoperative recovery was uneventful, and; at her 3-month follow-up the patient remains asymptomatic and an abdominal computed tomography scan demonstrated a cystic cavity of 15 cm diameter with no daughter vesicles, neither other abdominal organ involvement. This case is in line with the existing literature on laparoscopical treatment of splenic cystic hydatid disease, suggesting that laparoscopical treatment is a safe and effective approach for large splenic hydatid cysts to be preferred to open surgical techniques.

Surgical approach to splenic hydatid cyst: single center experience

The benefits and risks of surgery for splenic hydatid cyst (SHC) remain controversial. We aimed to share our experience about a surgical approach for SHC. Sixteen consecutive patients with SHC disease who underwent open splenectomy at our hospital between January 2006 and July 2012 were retrospectively evaluated. Data on the patients' demographic features, clinical findings, radiological and serological diagnostic methods, and surgical and medicinal treatment options were collected and used to generate descriptive profiles of diagnosis, treatment course, and outcome. The patient population was composed of 6 females and 10 males, with an age range of 18 to 79 years (mean age: 47.0 ± 18.0). Radiological examinations detected hydatid cysts in spleen alone (n = 7) or both spleen and liver (n = 9). Preoperative serological testing identified 13 of the patients as IHA positive. All except 1 patient received a 10- to 21-day preoperative course of albendazole therapy and all patients received vaccination 1 week prior to surgery. Seven patients underwent splenectomy. The remaining patients underwent splenectomy with partial cystectomy and omentopexy (n = 6), partial cystectomy and unroofing (n = 1), pericystectomy (n = 1), or pericystectomy with partial nephrectomy (n = 1). All except one patient received a 10- to 45-day postoperative course of albendazole. No patients developed serious complications or signs of recurrence during the follow-up. The clinical profile of SHC disease at our hospital includes diagnosis by radiological methods, splenectomy treatment by simple or concomitant procedures according to the patient's symptoms, cyst size, number and localization, and compression of adjacent organs, and adjunct vaccination to decrease risk of postoperative septic complications. This profile is associated with low risk of complications and high therapeutic efficacy.

Hydatid disease of the spleen: single-center experience and a brief literature review

BACKGROUND

The aim of this study was to discuss the management of patients with splenic hydatid cyst (SHC) and to provide a review of the literature in this field.

METHODS

The outcomes of patients surgically treated for SHC at the Diyarbakir Education and Research Hospital (DERH) between January 2006 and May 2013 were assessed by retrospectively reviewing demographic, radiological, and clinical data. In addition, the outcome profiles of these patients were compared to the overall outcomes of surgically treated SHC cases reported in the literature. Relevant case series (≥4 cases) were identified by searching the PubMed, Medline, and Google Scholar databases for publications from 1990 to May 2013 in English or Turkish languages.

RESULTS

Nine patients with SHC received surgical treatment at DERH (age range, 18-53 years old; mean, 36.9 ± 11.8; female/male, 7/2), including five (55.6%) primary SHC and four (44.4%) secondary (100% liver) SHC cases. Two patients had previous SHC surgery. Seven patients received albendazole therapy, both preoperative (10-21 days) and postoperative (10-42 days) periods. All patients received vaccination, either preoperative (n = 4) or postoperative (n = 5). Six patients underwent splenectomy and three underwent splenectomy with partial cystectomy and omentopexy, and no patient experienced SHC recurrence during follow-up (1-60 months). The literature review identified 27 full-text articles representing 333 surgically treated SHC cases, among which 60.5% had primary SHC and 39.5% had secondary SHC. Two hundred thirty of 333 patients underwent splenectomy, 81 underwent spleen-sparing surgery, and 17 underwent puncture, aspiration, injection, and reaspiration. The remaining five patients were not operated for various reasons.

CONCLUSION

We found no significant difference in recurrence rates between splenectomy and spleen-sparing surgery, either in our patient cohort or among cases reported in the literature. Nevertheless, we cannot make any solid recommendations for either procedure based on these results, as the studies were largely retrospective.

Hydatid Cyst of the Spleen: Tunisian Series of 21 Cases

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.

Splenic hydatid cyst: is splenectomy necessary?

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.

Hydatid Disease of the Spleen

Splenic echinococcosis is a rare disease even in endemic regions. The most commonly affected organ is the liver, followed by the lung and the spleen. In this article we discuss epidemiology, clinical presentation, diagnosis, pathophysiology, pathologic features, imaging findings, complications, differential diagnosis, and treatment of hydatid disease of the spleen.