Sawarappa Raghavendra, Kanoi Aditya, Gupta Madhumita, Pai Ashwin, Khadri S I S
Faculty, Department of General Surgery, SSKM and IPGMER Hospital , Kolkata, India .
Faculty, Department of Plastic Surgery, SSKM and IPGMER Hospital , Kolkata, India .
J Clin Diagn Res. 2014 Jun;8(6):ND03-4. doi: 10.7860/JCDR/2014/7088.4472. Epub 2014 Jun 20.
A 27-year-old female presented with pain in the left hypochondrium for the past six months. An abdominal examination revealed mild splenomegaly. An abdominal ultrasonography showed two cystic lesions at the superior pole of the spleen. Contrast enhanced CT scan abdomen confirmed the USG findings, demonstrating splenomegaly with nonenhancing cystic lesions having internal septations and suspicious daughter cysts within it, strongly suggestive of hydatid cysts. On serological testing, the patient was positive for IgG Antibodies against Eccinococcus. Following Pneumococcal vaccination, splenectomy was performed taking precautions to prevent accidental rupture or spillage of contents into the peritoneum. The postoperative period was uneventful with the patient making a swift recovery. Histopathological examination revealed extensive necrosis within the cysts. In the midst of the necrotic material, hooklets were seen. These features were consistent with a diagnosis of an infected Hydatid cyst. It is of utmost importance that a correct preop diagnosis is made since all precautions must be taken to prevent dissemination or seeding of the surgical field. Death has been reported due to anaphylactic shock resulting from spillage during excision or biopsy. The most important factor in diagnosing splenic hydatid cyst is the awareness of its possibility.
一名27岁女性在过去六个月中出现左季肋部疼痛。腹部检查发现轻度脾肿大。腹部超声显示脾脏上极有两个囊性病变。腹部增强CT扫描证实了超声检查结果,显示脾肿大,有不强化的囊性病变,内部有分隔,且其中有可疑的子囊,强烈提示为包虫囊肿。血清学检测显示,该患者抗棘球绦虫IgG抗体呈阳性。在接种肺炎球菌疫苗后,进行了脾切除术,同时采取预防措施以防止内容物意外破裂或漏入腹膜。术后恢复顺利,患者迅速康复。组织病理学检查显示囊肿内有广泛坏死。在坏死物质中可见小钩。这些特征符合感染性包虫囊肿的诊断。做出正确的术前诊断至关重要,因为必须采取一切预防措施以防止手术区域的播散或种植。据报道,因切除或活检时内容物溢出导致过敏性休克而死亡。诊断脾包虫囊肿最重要的因素是意识到其可能性。