Asian Journal of Case Reports in Surgery

Background: Hydatid disease is a parasitic infection commonly affecting the liver and lungs, while isolated splenic involvement is rare. Unilocular splenic hydatid cysts are uncommon and often present with nonspecific clinical symptoms, making diagnosis challenging.

Aims: To report a rare case of isolated unilocular splenic hydatid disease and to demonstrate the safety, feasibility, and clinical outcomes of a minimally invasive, spleen-preserving laparoscopic approach, including operative technique and perioperative management.

Presentation of Case: A 29-year-old male presented with a one-year history of dull, intermittent left hypochondrial pain. Imaging revealed a 5 × 4 cm unilocular cystic lesion at the superior pole of the spleen with internal septations and daughter cysts, classified as Gharbi Type II (WHO CE3b). Despite negative IgG serology, imaging characteristics were strongly suggestive of splenic hydatid disease. Following five days of preoperative albendazole therapy, laparoscopic spleen-preserving partial peri-cystectomy was performed using hypertonic saline as a scolicidal agent. Blood loss was minimal, and the postoperative course was uneventful. Histopathology confirmed an acellular laminated membrane with brood capsules and hydatid sand. At 12-month follow-up, the patient was asymptomatic with no evidence of recurrence.

Discussion: Isolated splenic hydatid disease accounts for less than 2% of all hydatid cases. Diagnosis relies on a combination of imaging and serology, though serological tests may be negative in up to 40% of splenic cases. Laparoscopic partial peri-cystectomy, combined with perioperative albendazole and meticulous intraoperative technique to prevent spillage, offers outcomes comparable to open surgery while preserving splenic immunological function.

Conclusion: Splenic hydatid disease warrants a high index of clinical suspicion, particularly in endemic regions. Laparoscopic management represents a safe and effective minimally invasive option, offering the dual advantages of spleen preservation and reduced postoperative morbidity when performed with meticulous technique and appropriate perioperative medical therapy.