ORIGINAL ARTICLE Selecting a Surgical Modality to Treat a Splenic Hydatid Cyst: Total Splenectomy or Spleen-Saving Surgery? Zulfu Arikanoglu & Fatih Taskesen & Hatice Gumus & Akin Onder & Ibrahim Aliosmanoglu & Mesut Gul & Omer Lutfi Akgul & Celalettin Keles Received: 3 December 2011 / Accepted: 2 February 2012 / Published online: 15 February 2012 # 2012 The Society for Surgery of the Alimentary Tract Abstract Aim We analyzed the outcomes and effectiveness of surgical treatments and clinical manifestations of splenic hydatid cysts. Patients and Methods Between 2000 and 2011, we retrospectively reviewed the cases of 11 patients who were operated on for a splenic hydatid cyst. The demographic features, medical history, physical examinations, biochemical and serological tests, imaging modalities, and surgical treatment of the patients were noted. Results The mean patient age was 36.45 years (range, 20–66 years). While isolated splenic hydatid disease was present in five patients, other abdominal hydatid cysts were accompanied by a splenic hydatid cyst in six patients. Left upper abdominal pain was present in seven (64%) patients, whereas four (36%) patients were asymptomatic. Eight patients (72.72%) had undergone a total splenectomy and three (27.28%) had undergone spleen-preserving surgery. Postoperative complications developed in four (36%) patients at 5–15 days postoperatively. Conclusion Management of a splenic hydatid cyst is not consensual. Total splenectomy is optimal because it provides definitive treatment. However, spleen-preserving surgery is the preferred treatment in selected patients. The choice of technique depends on the localization, number, and size of hydatid cysts, and the absence or presence of other hydatic organ cysts. Keywords Hydatid cyst . Spleen . Surgical treatment Introduction Although hydatid disease caused by Echinococcus granulo- sus is most frequently localized to the liver (60–70%) and lungs (20–30%), it can develop, albeit fairly rare, in any organ system in the body, 1–3 and the spleen is the third most frequent organ. In contrast, splenic hydatid cysts are rarely seen, even in countries where hydatic disease is endemic. A splenic hydatid cyst constitutes 0.5–4% of all hydatid dis- ease cases. In most cases, the liver and/or other organs are also involved, yet isolated splenic involvement is quite rare. 4–6 Splenic hydatid cysts are generally very slow growing and may maintain an asymptomatic clinical course for long periods of time. Symptoms tend to stem from impingement on the surrounding organs or from the development of complications. Symptoms generally include nonspecific findings such as abdominal pain, particularly in the left upper quadrant, dyspepsia, or an abdominal mass. 4,7,8 The diagnosis of a splenic hydatid cyst relies on medical history, physical examination, imaging tests, and serology tests. The diagnosis is established incidentally in asymptom- atic cases. 9 No consensus has been reached for surgical techniques. Accordingly, case reports published on this issue are limited in number. Some authors prefer a total splenectomy, whereas Z. Arikanoglu (*) : F. Taskesen : A. Onder : I. Aliosmanoglu : M. Gul : O. L. Akgul : C. Keles Department of Surgery, Dicle University Faculty of Medicine, 21280 Diyarbakir, Turkey e-mail: zulfuarikanoglu@gmail.com H. Gumus Department of Radiology, Dicle University Faculty of Medicine, 21280 Diyarbakir, Turkey J Gastrointest Surg (2012) 16:1189–1193 DOI 10.1007/s11605-012-1837-2