Giant Echinococcal Cyst of the Spleen Successfully Managed with Repeated Catheterization

We describe a patient with a giant splenic echinococcal cyst. As surgery was contraindicated and systemic benzimidazole treatment would likely be ineffective, the cyst was successfully managed with courses of catheterization and continuous drainage. Our patient had multiple comorbidities and two previous surgeries for abdominal cystic echinococcosis. Eleven years after the first surgical intervention, a computed tomography scan revealed a giant (18.5 × 13.5 cm) echinococcal cyst in stage CE3a (WHO-Informal Working Group on Echinococcosis classification) of the spleen. Percutaneous treatment (PT) was performed leaving the catheter in situ for spontaneous drainage in association with albendazole. The procedure was repeated four times over a 10-year period, without any complications. Albendazole administration was discontinued in 2009. Annual US follow-up showed a progressively smaller splenic cavity (final dimensions 7.2 × 6.8 cm). Although unconventional, the procedure was safe and effective. PT is a viable alternative when surgery is contraindicated and should only be performed by experts.