017-hydatid cyst spleen.p65

MC Vol.17-No.4-2011 ( 75-78 ) Shaikh A. S. et al
HYDATID CYST SPLEEN OUR
EXPERIENCE
SAIMA ATHAR SHAIKH,
ABSTRACT
SHAHID HUSSAIN SOOMRO,
AKLEEMA ABRO,
Objective: To determine the management out come of hydatid cyst spleen.
BUSHRA SHAIKH
Subject & Methods:
Study Design: Case series
Setting: Department of Surgery, Chandka Medical College Hospital Larkana
Study period: 15-04-2003 to 31-12-2010
Sample Size: 09 cases
Sampling technique: Nonprobability purposive.
Inclusion criteria: All patients diagnosed as case of hydatid cyst spleen and operated
were included in this study.
Exclusion criteria:
1
Assistant Professor of Surgery,
Patients diagnosed but not operated due to any reason (not willing or unfit).
Surgical Unit-III,
Data Collection: All the patients who met inclusion criteria were included in this
2
Assistant Professor of Surgery,
Surgical Unit-III,
After detailed history, proper clinical examination and investigations splenectomy was done in all patients. Following parameters were noted on specific designed proforma, including biodata of patient, presenting complaint, clinical findings and U/S findings. Post 3
Assistant Professor of Surgery,
operatively all patients were put on medical treatment( for 3 months) and followed for Surgical Unit-III,
a period of 1 year to observe recurrence rate.
Data Analysis: Data was entered and analyzed by SPSS version 13. Mean ± SD was
calculated for age of the patient, operative time and post operative hospital stay.
4
Post Graduate Trainee
Frequency and percentage was calculated for gender & clinical features.
Surgical Unit-III,
Results: 09 patients admitted through OPD and diagnosed as case of hydatid cyst
Age ranged from 22 to 56 years with mean and standard deviation was 41.45 years +/- 10.59. Majority of patients 4(44.4%) were in 5th decade. Male to female ratio was1:0.8 All the patients presented with mass in left side of abdomen (Splenomegally)followed by pain in 66.6%.
U/S confirmed hydatid cyst spleen in all cases, supported by positive serology. In 1patient it was associated with hydatid cyst liver as well.
Splenectomy was done in all cases; associated liver hydatid cyst was also excised inone patient.
No major complication observed. In 1 year follow up no recurrence observed.
Correspondence:
Conclusion: Hydatid cyst spleen is one of the presentation of hydatid disease after
DR. SAIMA ATHAR SHAIKH
liver & lungs. It should be considered on detection of splenic cyst on ultrasound, in Assistant Professor of Surgery,
endemic areas. Splenectomy is recommended as procedure of choice, either open or Surgical Unit-III,
Chandka Medical College TeachingHospital, Larkana.
Key Words: Splenic hydatid cyst, E. granulosis, splenectomy,
Tel: Res: 074-40466965Office: 074-9410705, 706 INTRODUCTION
Hydatid disease has been described in literature since ancient time and has global Quarterly Medical Channel
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MC Vol.17-No.4-2011 ( 75-78 ) Shaikh A. S. et al
distribution. Bertol in 1790, 1st described splenic hydatid cyst on TABLE NO: 1
autopsy findings.1Hydatid disease is endemic in agricultural areas especially Austra- AGE DISTRIBUTION
lia, New Zealand, Middle East, India, Africa, south America andTurkey. 2 AGE GROUP
NO: OF PATIENTS
It has world wide distribution and affects health and economicsof many countries throughout world.3 Hydatid disease has been eradicated in many countries. However it is still widespread in communities in which agriculture dominate.4 Hydatid disease is a common cystic disease of liver and other organs by flat worm, that is known to affect both human andanimals.4 These cestodes have a world wide distribution but TABLE NO: 2
prevalence is higher in developing countries. Infection is as lowas 1/1000 in north America to as high as 10% in 3rd world.5 CLINICAL FEATURES
Echinococcous granulosus is the organism responsible for typicalhydatid disease.4 This disease is caused by larva, after ingestion Clinical features
No of Patients
of contaminated food containing the tapeworm eggs. The defini-tive hosts are dogs while sheep are the intermediate hosts and human is the accidental intermediate host.5 Consumption of contaminated vegetables , meat or direct contact with dogs ex- poses man to larval forms of this disease.
Disease is chronic and cyst can lodge in different organs.6 Mostcommon sites are Liver (75%) and lungs (15%), although it can Exclusion criteria:
involve any organ in body. 6 Spleen is involved in about 4% of Patients diagnosed but not operated due to any reason (not cases 6 while other sites of involvement are brain, breast, thigh, bone, intra arterial, ovaries, adrenal, heart, mesentery, retroperi- toneal space, pancreas, scrotum, thyroid gland, neck, inguinal canal and soft tissues. 3,5,6. The symptoms are usually non spe- DATA COLLECTION:
cific and comprise of mainly a mass in left hypochondrium and All the patients who met inclusion criteria were included in this pain. The complications of untreated splenic hydatid cyst are infection and intra abdominal rupture. Severe anaphylactic reac- Purpose and procedure of the study was explained to the patient tion may occur following rupture. Hydatid cyst may be solitary in local language and informed consent was taken from the pa- or multiple involving single or multiple organs. Ultrasonography is the first line investigation for the diagnosis of abdominal hy- After detailed history, proper clinical examination and investiga- datidosis. It is non –invasive, cheap and also valuable for follow tions (routine, serology for Echinococcous antibodies and Ultra- up screening. CT scan best demonstrates the cyst wall calcifi- sound abdomen), all patients were operated. Splenectomy was done in all patients. Post operatively all patients were put on There are different serological tests for diagnosis including medical treatment (Albendazole) for E.granulosis for 3 months.
immunoelectrophoresis, ELISA, & Latex agglutination test.
Following parameters were noted on specific designed proforma, Splenectomy is the procedure of choice for splenic hydatid cyst.
including biodata of patient, presenting complaint, clinical find- Recently Laparoscopic approach has also been advocated for uncomplicated hydatid cyst of spleen.7,8 Albendazole and or All patients were followed for a period of 1 year and recurrence Praziquental are the drugs recommended for the treatment of disease 9, used preoperatively and postoperatively to preventrecurrences.
DATA ANALYSIS:
Hydatid cysts are common in our rural areas. Stray dogs should Data was entered and analyzed by SPSS version 13. Mean ± SD be eliminated from the society while there should be strict hy- was calculated for age of the patient, operative time and post gienic care of pet dogs. All vegetables should be washed thor- oughly before eating. Public should be made aware regarding this Frequency and percentage was calculated for gender and clinical MATERIAL & METHODS:
RESULTS:
Study Design: Case series
09 patients admitted through OPD and diagnosed as case of Setting: Department of Surgery, Chandka Medical College Hos-
hydatid cyst spleen were included in this study.
Age ranged from 22 to 56 years with mean and standard deviation Study period: 15-04-2003 to 31-12-2010
was 41.45 years +/- 10.59. Majority of patients 4(45.45%) were Sample Size: 09 cases
in 5th decade (table 1). Among these patients 5 were males and Sampling technique: Nonprobability purposive.
4 were females, with male to female ratio of 1:08.
Inclusion criteria: All patients diagnosed as case of hydatid cyst
All the patients presented with mass in left side of abdomen spleen and operated were included in this study.
(Splenomegally). Other features with their frequency and percent- Quarterly Medical Channel
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MC Vol.17-No.4-2011 ( 75-78 ) Shaikh A. S. et al
Splenectomy was performed in all the patients. One patient had U/S confirmed hydatid cyst spleen in all cases, supported by hydatid cyst liver as well which was excised simultaneously.
positive serology. In 1 patient it was associated with hydatid cyst Splenectomy has been described as procedure of choice in various other studies as well. 6,15,23 Due to low co-morbidity rates, simul- Splenectomy was done in all cases; associated liver hydatid cyst taneous excision of liver hydatid cyst is also recommended. 23,25 was also excised in one patient. The operative time ranged from Some studies also favour the spleen preserving surgery (enucle- 50 to 90 minutes with mean and standard deviation of 60 ation of cyst) where cysts are located at the margins of the Post operative recovery was unevent full in all cases. No major In one year follow up period no recurrence was observed, sup- complication observed. The post operative hospital stay ranged from 5 to 7 days with mean and standard deviation of 5.56 days+/- 0.73. In 1 year follow no recurrence was observed.
CONCLUSION:
Hydatid cyst spleen is one of the presentation of hydatid disease DISCUSSION:
after liver & lungs. It should be considered on detection of splenic Splenic hydatid cyst is rare as compared to the rest of abdominal cyst on ultrasound, in endemic areas. Splenectomy is recom- viscera and the incidence reported in literature is between 2 to mended as procedure of choice, either open or laparoscopic.
4%,12. Spleen is primary involved when the parasite reaches throughthe arterial route bypassing the liver and lungs. Spleen can also REFERENCES:
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