hydatid disease ( hd ) , which is caused by echinococcus granulosus , is a common parasitic infestation especially in endemic regions such as the middle east , mediterranean , and south american countries . even though it mainly involves the liver , it has been reported in nearly all parts of the body .
the incidence of the splenic cysts in hd varies from one series to another , ranges 0.54% of all cases of echinococcosis .
however , one study showed that hd is common in jordan , but isolated spleen disease is described only in 2.5% of cases .
symptoms of splenic hydatidosis is usually mild and is mainly caused due to pressure of adjacent organs such as colon / diaphragm or the presence of complications .
cysts may become infected or may rupture into the peritoneal cavity , especially subcapsularly located cysts like our case .
the hydatid fluid is antigenic and highly toxic and can cause a potentially fatal anaphylactic reaction in humans .
herein , we describe an acute happening of anaphylactic shock due to a spontaneous rupture of the primary isolated hydatid cyst in a 57-year - old woman .
a 57-year - old woman was admitted to the emergency department for diffuse maculopapular rashes on the whole body and anaphylactic shock .
she had been complaining of sudden- onset of abdominal pain , dyspnea , pruritus , and urticaria . on physical examination , it revealed tenderness , guarding , and rigidity all over the abdomen .
the patient recovered after emergency medications and then abdominal computed tomography ( ct ) revealed a splenic cystic lesion measuring about 9 6 cm in diameters and containing floating membranes .
the anterior wall of the cyst showed discontinuity at a point [ figure 1 ] .
then , the patient underwent a laparoscopic partial cystectomy and omentoplasty , since the spread of the disease into the peritoneal cavity of lesions was strong contraindications for a radical surgical approach . at the time of laparotomy
the postoperative course was uneventful , and the patient was discharged 10 days after the surgery .
we applied albendazole , 10 mg / kg / day for 6 months , and the patient was followed up with ct that displayed no recurrence of the disease during a follow - up of 6 months [ figure 3 ] .
computed tomography showed floating membranes in the splenic cystic lesion ( long arrow ) , rupture point ( short arrow ) , and perisplenic fluid ( open arrow ) intraoperative photograph shows a ruptured outer membrane of an echinococcal splenic cyst follow - up computed tomography image shows no residue or recurrence in spleen with omentopexy ( star )
hydatid disease is a parasitic infestation caused by the larva of echinococcus , more frequently encountered in endemic areas such as mediterranean countries , south america , africa , and middle east .
even though various theories have been published about the pathophysiology of splenic hydatidosis , the most suitable study was published by bourgeon et al .
the development of echinococcal cysts in the spleen is uncommon because hexacanth embryos are usually trapped in the liver ( first lemman 's filter ) or lung ( second lemman 's filter ) , but will be trapped in the splenic capillaries once in the systemic circulation .
splenic echinococcosis may also occur by retrograde reach from the liver to the spleen via the portal and splenic veins in portal hypertension .
the spleen may also be affected due to rupture of a hepatic echinococcal cyst into the peritoneal cavity .
patients remains asymptomatic for 520 years before the diagnosis , and approximately 30% of splenic cysts are asymptomatic . in these asymptomatic patients ,
when the cyst reaches a huge size , it presents with a painful mass in the left upper quadrant .
if the cyst is infected , or abscess formation has been occurred , left upper quadrant pain , fever , and leukocytosis develop .
rupture into the abdominal cavity is a rare but serious complication because the hydatid fluid is antigenic and highly toxic .
anaphylactic reaction to the hydatid cyst usually occurs after microscopic or macroscopic rupture of the cyst and leakage of contents into the peritoneum or blood circulation .
the response can be vary from a mild hypersensitivity reaction to a fatal anaphylactic shock .
rupture of a splenic hydatid cyst occurs commonly secondary to trauma , but it may also rarely occur spontaneously such as our patient .
the diagnosis is mainly historical and geographic background of the patient , physical examination , serology , and visualization of peripheral calcification or daughter cysts within the large cystic lesion or coexistent cystic lesions with radiologic examination in the liver or other organs .
ultrasound and ct imaging have been used successfully in the detection of a ruptured hydatid cyst . at present
, ultrasonography is the most valuable and most widely available imaging modality for the diagnosis , classification , and follow - up of splenic hydatid cysts .
ct is more sensitive than plain films or sonograms in depicting subtle cyst wall calcification .
ct is an important imaging modality to have the actual number and location of the cysts not only in the spleen , but also in the abdomen .
the presence of a cyst in the spleen of a patient who developed anaphylactic reaction with detection of membrane - like structures inside the cyst and discontinuity of the wall are considered diagnostic for ruptured hydatid cysts such as our patient .
surgical excision is still the only curative treatment , but good results have been reported with albendazole administration .
medical treatment is indicated in cysts inaccessible for surgical removal or as a complementary therapy to prevent recurrence .
the surgical procedure consists of removing the cyst and possible daughter cysts spilled into the abdominal cavity in combination with peritoneal washing .
total splenectomy is advocated by the majority of surgeons , especially for patients with large cysts located centrally or near the hilus , since it gives rise to minimal risk of recurrence .
laparoscopic or laparoscopically assisted splenectomy has also been successfully used for echinococcal disease of the spleen .
atmatzidis et al . showed that the recurrence rate after total splenectomy was not significantly different compared to spleen - preserving surgery , and the complication rate and hospital stay were also comparable between these two groups .
in summary , the hydatid cyst is still a serious health problem in endemic areas as well as in our country .
although the liver and lung are the most frequently involved organs , primary splenic hydatidosis is quite rare .
hydatid cyst must be considered in the differential diagnosis of patients presenting with anaphylactic shock in areas where the disease is endemic and even in nonendemic .
 echinococcosis is a helminthic zoonosis mainly caused by echinococcus granulosus and commonly encountered in endemic areas . 
 the liver and lung are the most frequently involved organs . a primary isolated hydatid cyst of spleen is an extremely rare disease even in endemic areas . 
 anaphylactic reaction is a known complication of cystic hydatid disease , a parasitic infestation caused by the larval / cyst stage of e. granulosus that usually occurs after trauma or during interventions . to the best of our knowledge , 
 anaphylaxis with spontaneous rupture of primary isolated splenic hydatidoses had not been reported previously . 
 the main purpose of this report is to highlight life - threatening complications such as anaphylactic shock that should be considered due to primary isolated splenic cyst hydatid rupture in especially endemic regions . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION