A Rare Case Report of Isolated Multiloculated Splenic Hydatid Cyst Presenting with an Incisional Hernia

Abstract

Cystic echinococcosis is a parasitic zoonosis caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most frequently involved organs due to portal and pulmonary filtration, whereas primary splenic involvement is uncommon, accounts for only a small proportion of cases. Isolated splenic hydatid cysts often present with vague or non-specific symptoms and may mimic other benign or neoplastic cystic lesions, resulting in diagnostic uncertainty. A 47-year-old woman presented with a progressively enlarging supraumbilical swelling of one year’s duration, accompanied by intermittent abdominal discomfort. Physical examination revealed a palpable mass in the left upper abdomen along with a reducible incisional hernia. Radiological evaluation demonstrated a large, well-defined multiloculated cystic lesion measuring 16.9×13.9×9.7 cm within the splenic parenchyma, with internal septations consistent with daughter cysts, with no evidence of involvement of other organs. Serological testing for Echinococcus infection was positive, supporting the suspected diagnosis. The patient underwent total splenectomy. Intraoperative findings confirmed extensive replacement of splenic parenchyma by multiple cystic cavities. Histopathological examination established the diagnosis by demonstrating the characteristic laminated cyst wall, germinal layer, brood capsules, and protoscolices. The postoperative course was uneventful. The patient received recommended post-splenectomy immunisations and adjunctive albendazole therapy to reduce the risk of recurrence. This case highlights the importance of considering hydatid disease in the differential diagnosis of splenic cystic lesions, even in patients without classical epidemiological risk factors. Radiological imaging and histopathological examination remain essential for diagnosis, while complete surgical excision combined with antiparasitic therapy offers excellent clinical outcomes.