A case of simultaneous huge splenic and mesenteric hydatid cyst in a 91-year-old male patient. The patient was presented with chronic abdominal pain, increased frequency of defecation, and a typical history of animal contact (cattle, sheep, and dogs). After performing imaging studies, he was diagnosed with a simultaneous huge spleen and pelvic mesentery hydatid cyst that was managed surgically by splenectomy, pelvic mesenteric cyst deroofing, and partial cystectomy.
A 91-year-old male patient presented with one month history of lower abdominal pain associated with increased frequency of defecation as well as dysuria. The patient did not have bloody diarrhea, fever, or any constitutional symptoms. The patient lives in a rural farm with typical history of animal contact (cattle, sheep, and dogs). Abdominal examination was notable for splenomegaly and tender suprapubic fullness. Laboratory tests did not show any abnormalities.
The computed tomography (CT) scan of the abdomen and pelvis revealed a large cystic lesion replacing almost all the spleen with displacement of the stomach and pancreas. A similar huge pelvic cystic lesion is seen at the rectovesical region compressing the urinary bladder and both ureters with bilateral hydronephrosis. The diagnosis was splenic and mesenteric HD.
Patient was kept on albendazole 400 mg oral tablet twice per day for 3 weeks before the date of surgery. We started with splenectomy through midline incision. Then proceeding with the pelvis mesenteric cyst that was firmly adherent to the rectum and to the urinary bladder and both ureters. Deroofing of the cyst with partial cystectomy was done. Aspiration of the cyst content with injection of hypertonic saline was performed without spillage of the contents, followed by excision of an inner germinal layer of the cyst.
Patient had uneventful recovery and was discharged home on the sixth postoperative day to continue on the same dose of albendazole for more 2 weeks.
Histopathology examination confirmed the diagnosis of HD of both splenic and mesenteric cysts