Methods
The patient was admitted with initial suspicion of gastrointestinal malignancy and underwent diagnostic and therapeutic measures. In the preliminary tests, there were no other abnormal findings except for low hemoglobin, MCV, serum iron and ferritin, and high FBS and HbA1C. Abdominal ultrasound showed evidence of a cystic liver lesion, splenomegaly and multiple spleen lesions favoring a hydatid cyst. Next, the patient was tested for hydatid serology, which was negative. For further investigation, a CT scan was performed for the patient. CT scan result of the lung was not remarkable. In the CT scan of the abdomen and pelvis, there was evidence of splenomegaly (AP: 174mm) and the appearance of at least 6 cystic lesions (with the largest being 92x108mm), one calcified cyst (23x33x43mm) in the 6th segment of the liver. In addition, there were a large number of peritoneal nodules in different regions of the abdomen (with the largest being 48x27mm) and at least 6 hypodense structures (with the largest being 45x67x54mm) in the middle part of the omentum and above the umbilicus, for which hydatid cysts, primary neoplastic or metastatic lesions to the peritoneum were included in the differential diagnosis (fig. 1). Considering the anemia and weight loss and the possibility of peritoneal seeding, hydatid cyst could not fully explain the condition, so the patient underwent further diagnostic measures to investigate the cause of anemia. In colonoscopy, the only abnormal finding was internal hemorrhoid grade I, and endoscopy had no other significant findings except for small size sliding hiatal hernia.
Later, patient underwent diagnostic laparoscopy. One port was placed below the navel and the other was placed on the right side. In the general exploration of the abdomen, there was evidence of extensive involvement of the omentum with many nodular lesions, splenomegaly, and several large cysts of the spleen and one liver cyst. Stomach, small intestine and colon were examined completely and had no pathological findings. Several samples of nodular omentum lesions were obtained and sent for frozen section examination. The initial pathology report showed omental hydatid lesions. Therefore, the patient underwent laparotomy and splenectomy. Macroscopically, the size of the spleen was 14 x 16 x 19 cm and its weight was 686 grams with an irregular surface containing several cysts (fig. 2). Also, parts of the omentum that had evidence of involvement with hydatid lesions were removed (fig. 3). Abdominal cavity and pelvis were thoroughly re-examined, no other pathology was found and surgery was complete.
Later, patient received 13-valent pneumococcal vaccine and was treated with albendazole 800 mg daily, oral iron and folic acid, and was discharged 3 days later in favorable general condition. Patient was also advised to receive the 23-valent pneumococcal vaccine two weeks later. The final pathology report also showed omental and splenic hydatid cyst (fig. 4). In 3 and 6 months of follow-up, the patient’s abdominal pain had improved and general examinations were normal. Liver enzymes had not increased significantly. A control ultrasound was also performed and there were no other pathological findings except for calcified hepatic cyst.