Isolated splenic hydatid cyst in a 5-year-old girl- a rare case report with a rare presentation

Cystic echinococcosis (CE), or hydatid cyst, is a zoonotic disease caused by the larval form of the cestode Echinococcus, with Echinococcus granulosus accounting for 95 % of all cases of hydatid disease. It typically affects the liver and lungs, while primary involvement of the spleen is extremely rare, occurring in only about 2 % to 3.5 % of reported cases. Diagnosis can be particularly challenging when the spleen is primarily affected especially in a young pediatric patient. However early diagnosis and management of such cases are essential to prevent severe fatal complications such as anaphylactic reactions, shock, or even death. We present a case of a 5-year-old girl from Hebron, Palestine, presented with a one-year history of left upper abdominal pain, anorexia, and vomiting. Imaging revealed a huge solitary splenic cyst. A cystectomy and splenectomy were performed, confirming E. granulosus infection. Postoperative recovery was uneventful, with albendazole therapy and vaccinations administered. Despite awareness of the possibility of splenic involvement, primary hydatid infection of the spleen remains extremely rare in a five-year-old pediatric patient. This case highlights the unusual occurrence of primary splenic hydatid disease in young children, emphasizing the need for its inclusion in differential diagnoses for abdominal pain, even in the absence of typical risk factors. Radiologic and serological assessments are crucial for diagnosis. Surgical intervention remains the mainstay of treatment, with total splenectomy preferred in complex cases. Primary splenic hydatid cysts can present in pediatric patients with non-specific symptoms. Considering this condition in the differential diagnosis for left upper quadrant pain can lead to more timely and accurate diagnosis and management.