case_images: PMC9876700_01
case_images: 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
case_images: cureus-0015-00000034206-i01.jpg
case_images: PMC9876700_01_cureus-0015-00000034206-i01.jpg
case_images: FIG1
case_images: 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).
case_images: Serial CT imaging showing an interval decrease in the size of the cyst due to pharmacological interventions
case_images: cureus-0015-00000034206-i02.jpg
case_images: PMC9876700_01_cureus-0015-00000034206-i02.jpg
case_images: FIG2
case_images: 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.
case_images: 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.
case_images: cureus-0015-00000034206-i03.jpg
case_images: PMC9876700_01_cureus-0015-00000034206-i03.jpg
case_images: FIG3
case_images: 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).
case_images: 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.
case_images: cureus-0015-00000034206-i04.jpg
case_images: PMC9876700_01_cureus-0015-00000034206-i04.jpg
case_images: FIG4
case_images: 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).