HYDATID DISEASE OF THE SPLEEN AND PORTAL HYPERTENSION: IS IT A CAUSAL RELATIONSHIP, COMPLICATION OR A COINCIDENTAL FINDING. EVALUATION OF THE MANAGEMENT OPTIONS | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 22, Issue 3, July 2003, Page 261-271 PDF (384.67 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2003.374513 | ||||
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| Authors | ||||
| Magdy M A Elsebae* 1; Sameh B Elsebaie1; M. Emad Esmat1; Nagi E Meckail1; Ahmed Sadek2; Mahmoud El ansary2 | ||||
| 1General Surgery Departments, Theodore Bilharz Research Institute, Cairo -Egypt | ||||
| 2Tropical Medicine Departments, Theodore Bilharz Research Institute, Cairo -Egypt | ||||
| Abstract | ||||
| Although, Invasion of the spleen is rare in hydatid disease, the spleen is the third common organ involved by hydatid cysts. Despite there is not a consensus about the way of treatment, it should be surgical to avoid complications. Splenectomy has been the treatment of choice however; attempting to preserve as much splenic tissue has been possible. Segmental portal hypertension due to splenic hydatid disease has been mentioned in the literature in a few case reports. An occasional association between hypersplenism and splenic hydatidosis has been also, reported. The authors hypothesize that there is a possibility of altered portal venous hemodynamics as a cause of lodgment of the Echinococcus embryo into the spleen leading to hydatid cyst formation. Aim of the study: Evaluation of the surgical treatment options for hydatid disease of the spleen. A special emphasis is done on the possible relationship between splenic hydatidosis and portal hypertension and /or hypersplenism. Patients & methods: Between 1998-2003 fourteen patients with diagnosed splenic hydatidosis were treated. Patients were fully evaluated by clinical examination, detailed abdominal sonography, and routine laboratory studies. Assessment for portal hemodynamics was done by Doppler ultrasonography and direct measurement of splenic and portal venous pressures via simple manometer at operation. Testing for hypersplenism was done by full blood picture and bone marrow biopsy if needed. Liver histopathological study was performed to exclude or prove co-existing liver cirrhosis. All patients included in the study underwent surgical treatment and percutaneous treatment was the initial option in five of them. Results: The evidence of portal hypertension was found in only three patients (21.4%) (one with hepatosplenic hydatid cysts and two with hydatid cyst of the spleen only). Those three patients had bilharzial liver fibrosis on histopathological study. None of the patients have had hypersplenism. Eight of the patients underwent splenectomy including the three patients with associated bilharzial portal fibrosis. Endocystectomy and omentopexy was performed for five patients and a partial splenectomy was done for another patient. There was no mortality and no major postoperative complications occurred. Conclusion: Hydatid cysts of the spleen do not cause portal hypertension per se and so far, portal hypetension can not explain splenic localization of hydatid disease. Hypersplenism was not found in those patients with splenic hydatid cysts. Splenectomy is the standard treatment of splenic hydatid cysts; however, spleen- preserving surgery is feasible and safe in selected cases. Percutaneous drainage of abscessed splenic lesions must be avoided particularly when hydatid disease is suspected. | ||||
| Keywords | ||||
| Spleen hydatidosis; Treatment | ||||
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