An unusual presentation of primary splenic hydatid cyst
A 28-year-old male patient presented to us in the OPD of a rural medical setup of West Bengal, India, with a complain of left upper abdominal swelling with heaviness for the last 1 year and generalized weakness. He was a cultivator from a rural area and had close contact with cattle and dogs.\nOn examination, the left upper abdomen was found bulged [], umbilicus centrally placed, and liver not palpable; the spleen was enlarged 15 cm below the left costal margin, and slightly tender. The rest of the physical examination was normal.\nRoutine investigation revealed hemoglobin 11.1 g/dl, total leukocyte count 11.800/mm3, and differential leukocyte count as follows: neutrophil 67%, lymphocyte 23%, eosinophil 8%, macrophage 2%, and basophil 0%. Liver function tests, BUN, creatinine, and blood sugar were normal. X-ray of the abdomen showed a soft tissue shadow without any calcification. Abdominal USG reported an enlarged spleen with a well-defined unilocular cystic lesion without evidence of daughter vesicles. Sonographic and radiographic studies did not show any other cysts in the liver or lungs.\nOn laparotomy, through an upper midline incision, we found the cystic lesion involving almost whole of the spleen. The aspiration of the cyst showed a clear content. After complete aspiration without any spillage, the cyst wall was incised. A clear, white, definite germinal layer of a hydatid cyst without any daughter cyst was found []. Splenic cystectomy was done. The patient had an uneventful postoperative recovery and was discharged on the eighth post-operative day. The patient was given oral albendazole 400 mg bid for 4 weeks as a prophylactic measure against secondary hydatidosis. He was well at 1 and 2 years of follow-up after surgery. Histopathology of the specimen confirmed a hydatid cyst.