PMC9876700_01
Axial view of CT portal venous showing the size of the isolated splenic hydatid cyst and associated mass effect. Arrow indicates a small proportion of the remaining splenic parenchyma, encasing a large cyst
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FIG1
Preliminary investigation in the community included positive Strongyloides immunoglobulin G, and as such, arrangements were made for further investigation, including hydatid serology (positive), abdominal ultrasound (non-specific, left, upper quadrant cystic changes) and CT portal venous of the abdomen and pelvis, which showed a 150x180x100 mm well-defined cyst with homogenous fluid density (Figure 1).
Serial CT imaging showing an interval decrease in the size of the cyst due to pharmacological interventions
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FIG2
At this time, repeat cross-sectional imaging (Figure 2) showed an interval reduction in the size of the cyst to 79x63x77 mm; however, given the increase in symptomatology, a discussion was held between the treating surgical and infectious disease teams and with the district's quaternary hepatobiliary service, and a consensus was reached to proceed to splenectomy.
Intraoperative laparoscopic photograph showing considerable splenomegaly. A Hemoloc clip and Endo-GIA linear staples are visible post-control and dissection of the splenic artery and vein.
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FIG3
The gastrosplenic ligament was taken down, and the splenic artery and vein were identified and controlled using a Hemoloc clip to the artery followed by an Endo-GIA 60 mm linear stapler across both the artery and vein (Figure 3).
Cyst containing the spleen, successfully resected and removed. The image shows the spleen once received at the facility's pathology lab, cut into four in preparation for sectioning and analysis.
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FIG4
Inferior dissection of the splenocolic ligament and subsequent medial-to-lateral dissection of the spleen with the division of the splenophrenic ligament allowed for the liberation of the spleen, and the spleen delivered whole in an Endocatch bag via a Pfannenstiel incision with no rupture or spillage and no immediate postoperative complications (Figure 4).