Laparoscopic spleen-preserving management of a large primary splenic hydatid cyst: a case report

Splenic hydatid disease is a rare manifestation of Echinococcus granulosus infection, accounting for less than 2% of all hydatid cysts. Total splenectomy has traditionally been the standard treatment; however, spleen-preserving laparoscopic approaches are increasingly advocated to reduce morbidity and avoid overwhelming post-splenectomy infection.

A 40-year-old female presented with several months of left upper quadrant pain radiating to the shoulder, recently associated with intermittent fever and nausea. She lived in an endemic rural area with possible exposure to livestock and dogs. Laboratory investigations revealed elevated C-reactive protein and positive Echinococcus serology. Imaging demonstrated an 8 × 7 cm primary splenic hydatid cyst involving the mid and lower poles. After 5 days of preoperative albendazole according to institutional protocol, laparoscopic cyst evacuation, partial pericystectomy, and omentoplasty were performed using a three-port technique. Recovery was uneventful, and the patient was discharged on postoperative day 3. At 4-month follow-up, the patient was asymptomatic with no recurrence.

Despite the large size of the cyst and dense adhesions, a laparoscopic spleen-preserving approach was selected to maintain splenic function and minimize morbidity. Meticulous use of scolicidal agents and controlled aspiration prevented spillage and recurrence.

This case highlights that laparoscopic spleen-preserving surgery is feasible and safe for large primary splenic hydatid cysts in experienced hands, even in technically challenging scenarios.