Laparoskopska parcijalna pericistektomija ehinokokne ciste slezene – prikaz bolesnice [Laparoscopic partial pericystectomy of splenic hydatid cyst - a case report]

Bušić, Željko and Kolovrat, Marijan and Đuzel, Antonija and Rakić, Mislav and Čavka, Mislav and Begović, Amela and Kopljar, Mario and Patrlj, Leonardo (2015) Laparoskopska parcijalna pericistektomija ehinokokne ciste slezene – prikaz bolesnice [Laparoscopic partial pericystectomy of splenic hydatid cyst - a case report]. Liječnički vjesnik, 137 (11-12). pp. 361-363. ISSN 0024-3477

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Abstract

Echinococcal cyst of the spleen is usually a result of infection with the parasite Echinococcus granulosus. The spleen is the third most frequent localization of echinococcus after liver and lungs. Partial laparoscopic pericystectomy can be done without the loss of blood and scattering of scolexes with spleen preservation and conservation of its immune function. We present the patient with a large (1 8 x 16 x 12 cm) echinococcal cyst of the spleen that compressed the surrounding organs (stomach, transverse colon, pancreas and left kidney), and prevented normal passage causing vomiting after every meal. In this patient, PAIR procedure (puncture, aspiration, injection, reaspiration) and conservative treatment was attempted on several occasions without success. Finally, laparoscopic partial pericystectomy was performed, evacuating the contents of the cyst. The surgery lasted 120 minutes. Postoperatively the patient was without complications. Hospitalization lasted five days. Six months later, the patient is without problems. These echinococcus cysts of the spleen cannot be solved using PAIR technique and conservative treatment. Laparoscopic partial pericystectomy is a better solution than open surgery due to less trauma to the patient, especially in elderly people.

Abstract in Croatian

Ehinokokna cista slezene redovito je posljedica infekcije parazitom Echinococcus granulosus. Slezena je treća najčešća lokalizacija ehinokoka, nakon jetre i pluća. Parcijalna laparoskopska pericistektomija može se učiniti bez gubitka krvi i rasapa skoleksa s prezervacijom slezene i očuvanjem njezine imunosne funkcije. Prikazana je pacijentica s velikom (18 × 16 × 12 cm) ehinokoknom cistom slezene koja je pritiskala okolne organe (želudac, poprečni kolon, pankreas i lijevi bubreg), onemogućavajući normalnu pasažu i izazivajući povraćanje nakon svakog obroka. Kod bolesnice su u nekoliko navrata neuspješno pokušani postupak PAIR (punkcija, aspiracija, injekcija, reaspiracija) i konzervativno liječenje te je naposljetku učinjena laparoskopska parcijalna pericistektomija s evakuacijom sadržaja ciste. Zahvat je trajao 120 minuta. Postoperacijski tijek protekao je bez komplikacija. Hospitalizacija je trajala 5 dana. Šest mjeseci kasnije bolesnica je bez tegoba. Ovakve ehinokokne ciste slezene nije moguće ukloniti tehnikom PAIR i konzervativnim liječenjem. Laparoskopska parcijalna pericistektomija bolje je rješenje od otvorene operacije zbog manje traume za organizam, osobito kod starijih ljudi.

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