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.