Case Report: A giant ruptured splenic hydatic cyst in a patient with a complete situs inversus: Diagnostic challenge and intra-operative difficulties

Amina Chaka; Wael Boujelbène; Amin Chaabouni; Mohamed Ali Bahloul; Nizar Kardoun; Salah Boujelben

doi:10.12688/f1000research.159480.2

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Case Report

Revised

Case Report: A giant ruptured splenic hydatic cyst in a patient with a complete situs inversus: Diagnostic challenge and intra-operative difficulties

[version 2; peer review: 1 approved, 2 approved with reservations]

Amina Chaka¹, Wael Boujelbène ¹, Amin Chaabouni¹, Mohamed Ali Bahloul¹, Nizar Kardoun¹, Salah Boujelben¹

Amina Chaka¹, Wael Boujelbène ¹, [...] Amin Chaabouni¹, Mohamed Ali Bahloul¹, Nizar Kardoun¹, Salah Boujelben¹

PUBLISHED 10 Jan 2025

Author details Author details

¹ General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Sfax, Tunisia

Amina Chaka
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Wael Boujelbène
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Writing – Original Draft Preparation, Writing – Review & Editing

Amin Chaabouni
Roles: Conceptualization, Data Curation, Investigation, Resources, Writing – Original Draft Preparation

Mohamed Ali Bahloul
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Nizar Kardoun
Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Visualization

Salah Boujelben
Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Visualization

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Pathogens gateway.

Abstract

The splenic localization of hydatid cysts is extremely rare. A 50-year-old obese female who consults with a painful and febrile syndrome of the right hypochondrium. Abdominal ultrasound and a CT scan computed tomography revealed a complete situs inversus, a mass of the right hypochondrium measuring 152 mm with membrane detachment, and infiltration of the surrounding fat, evoking a type II complicated splenic hydatic cyst. The patient was operated on in an emergency via midline laparotomy. Exploration revealed situs inversus, an angiant cyst of the spleen. Exposition of the splenic pedicle is difficult. The samples were then infected. Total splenectomy was performed. The postoperative period was unproblematic, and the patient was discharged with antibiotic and antiparasitic treatment and habitual vaccination.

Keywords

spleen, hydatid cyst, echinococcosis, situs inversus, splenectomy, case report

Corresponding author: Wael Boujelbène

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Chaka A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Chaka A, Boujelbène W, Chaabouni A et al. Case Report: A giant ruptured splenic hydatic cyst in a patient with a complete situs inversus: Diagnostic challenge and intra-operative difficulties [version 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2025, 13:1480 (https://doi.org/10.12688/f1000research.159480.2) First published: 04 Dec 2024, 13:1480 (https://doi.org/10.12688/f1000research.159480.1) Latest published: 02 Jun 2025, 13:1480 (https://doi.org/10.12688/f1000research.159480.3)

Revised Amendments from Version 1

The revised version of the article addresses several important aspects raised during the review process.
Firstly, the manuscript has undergone a thorough revision to correct the typos and grammatical errors identified in the previous version, ensuring a higher standard of clarity and professionalism throughout.
In response to the comment about the role of medical treatment in preoperative preparation and postoperative regimens, the updated version includes a more detailed discussion on the importance of medical management. This section now highlights the specific interventions that contributed to the patient’s recovery and provides a clearer rationale for the medical approaches used. Additionally, the revised article incorporates a more comprehensive analysis of the significance of the case findings in relation to broader disease processes, diagnosis, and treatment. The importance of the case is now framed in the context of future understanding, specifically addressing how the findings can inform future research and clinical practice. To improve the utility of the case for other practitioners, more practical details have been added to ensure that the report is not only informative but also useful for clinical application.
Lastly, the structure of the article has been aligned with the accepted standards for writing case reports, ensuring that it meets the required format and includes all essential sections for a complete and scientifically rigorous presentation.

See the authors' detailed response to the review by Ali Bilal Ulas
See the authors' detailed response to the review by Silvio Buscemi
See the authors' detailed response to the review by Selmy Awad

Introduction

Splenic hydatic localization is extremely rare, with a worldwide incidence rate of 0.5%-4%.¹ Abdominal left hypochondrium pain, mass, and fortuitous discoveries are the most frequently discovered complications.^1,2 However, right hypochondrium pain due to a splenic hydatic cyst associated with situs inversus is an exceptional finding. Here, we report the case of a 50-year-old female, who underwent surgery in our department for a complicated splenic hydatic cyst with situs inversus.

Observation

Patient information

A 50-year-old female, without no medical history presented to the emergency department with right hypochondrium pain.

Clinical findings

On physical examination, the patient was febrile at 38,4°C; anicteric, with tenderness of the right hypochondrium on abdominal examination. The hemodynamic status was stable.

Diagnostic assessment

Blood analysis showed a biological inflammatory syndrome. The liver test was normal.

In the face of a 50-year-old obese female who consulted for a painful and febrile syndrome of the right hypochondrium, an abdominal ultrasound was performed, which showed a complete situs inversus and a mass of the right hypochondrium with a membrane detachment, measuring 152 mm, evoking a type II splenic hydatic cyst.

Computed tomography (CT) revealed a large cystic formation in the spleen, measuring 15 cm in its largest dimension. The cyst exhibited a detached internal membrane, a characteristic sign suggestive of a type II hydatid cyst according to the Gharbi classification. Additionally, there was evidence of surrounding fat stranding and infiltration, indicative of local inflammatory changes. These findings strongly suggest a complication, specifically a hydatid cyst cracking (Figures 1, 2).

Figure 1. Splenic hydatid cyst cracking in a complete situs inversus 1.

Figure 2. Splenic hydatid cyst cracking in a complete situs inversus 2.

Therapeutic intervention

The patient underwent an emergency midline laparotomy. The exploration revealed a situs inversus, a voluminous splenic cyst occupying over 80% of the splenic volume. Exposition of the splenic pedicle is difficult. The cysto-parietal and cysto-visceral adherences, giant size of the cyst, and obesity prevented good exposure, which led to the decision to empty the cyst content after protecting the operating field with a field soaked in hypertonic serum. The samples were then infected.

Equally, the choice of the type of surgery, whether a total splenectomy or a protruding dome resection in an emergency context with complications such as cracking and surinfection, was not easy.

However, in the face of an emergency, the primary localization in the spleen, we performed a total splenectomy that allowed healing of the infested organ and avoided recurrence and surinfection of the residual cavity.

The overture of the cyst objectified the proligere membrane (Figure 3).

Figure 3. The splenectomy specimen and the proligere membrane of the hydatic cyst.

Follow up and outcomes

The post-operative period was unproblematic, and the patient was discharged with antibiotic and antiparasitic treatment and habitual vaccination.

Treatment with albendazole 400 mg twice daily was initiated from post-operative day 1, with cycles consisting of three 28-day treatments at 2-week intervals. Serum anti-Echinococcus antibody titers (hemagglutination test and ELISA) were positive in the immediate postoperative period (titers of 1/1280 and 1.9, respectively). Subsequently, the titers gradually decreased until achieving a negative serology at 2 years post-operatively. Liver function tests and complete blood counts were performed after each cycle and did not reveal any abnormalities during the treatment period. The abdominal CT scan did not reveal any recurrence of cystic echinococcosis in the thoraco-abdominal regions, particularly in the peritoneal area, with a current follow-up period of 3 years.

Discussion

Hydatic cysts are a common pathology in endemic countries. The most frequent locations are the liver and lungs.² Splenic localization is extremely rare, with a worldwide incidence rate of 0.5%-4%.¹

To our knowledge, this is the first reported case of a giant splenic hydatid cyst associated with situs inversus. In our case, the cyst was also ruptured into the abdomen, which posed both a diagnostic and therapeutic challenge.

Based on the literature of some published cases of splenic primary localization, the pain, discovery of a left hypochondrium mass, and fortuitous discoveries are the most frequent discovery circumstances or during complications such as infection and splenic abscess, rupture with an anaphylactic shock, and dissemination to other organs.^1,2

Ultrasound, computed tomography, and magnetic resonance imaging of the abdomen allow for diagnosis by objectifying membrane detachment and calcifications on the daughter vesicle wall.^2,3 In the case of a complicated cyst, cross-sectional imaging, particularly CT scans, can establish the diagnosis in an emergency while also allowing for the assessment of the cyst’s location and its anatomical relationships.^2,3

The treatment of splenic hydatic cysts is surgical. Total splenectomy has the advantage of avoiding recurrences. Protruuding dome resection has the advantage of being a conservative intervention of the organ and its functions and is slightly hemorrhagic at the cost of a considerable rate of residual cavity surinfection.^4–6

The surgical approach depends on the localization of the splenic hydatic cyst(s) and its association with other cystic localizations.^4,7 The laparoscopic approach is realizable in almost all cases, with good short-term and long-term results.^6–8

Regarding complicated cysts, the treatment of a ruptured hydatid cyst typically relies on urgent surgical intervention,^4–6 followed by medical therapy to prevent and manage peritoneal echinococcosis.⁹ However, Carola Buscemi et al.⁹ reported a case where prolonged treatment with albendazole was employed over 10 years for peritoneal, hepatic, and splenic hydatidosis, including a ruptured cyst. The albendazole protocol consisted of 400 mg administered twice daily for three cycles of 28 days each, with a 14-day break between cycles. This treatment was well-tolerated, and the hydatidosis showed favorable progression under this regimen.

Such cases highlight the potential for medical therapy as a complementary or alternative approach in selected cases, particularly when surgery poses high risks or is incomplete. However, further randomized prospective studies are needed to establish standardized protocols and optimize the management of this common yet complex condition.

Conclusion

Isolated splenic hydatid cysts are uncommon and present significant challenges in both diagnosis and surgical intervention. Advanced imaging techniques, particularly computed tomography (CT), play a pivotal role in accurately identifying the condition and planning the appropriate treatment strategy. In this case, preoperative imaging not only confirmed the diagnosis but also provided valuable insights into the cyst’s size, location, and relationship with adjacent structures, which were critical for minimizing intraoperative risks and guiding the surgical approach.

Patient perspective

The patient was satisfied with treatment with good follow-up after one year.

Informed consent statement

Written informed consent for publication of their clinical details and clinical images was obtained from the patient.

Data availability statement

No data are associated with this article.

References

1. Hassan A, Azhar A, Mazhar S, et al.: A rare case of recurrent hydatid cyst of the spleen: A case report. Radiol. Case Rep. oct 2023; 18(10): 3406–3409. PubMed Abstract | Publisher Full Text | Free Full Text
2. Singh S, Kisee S, Amatya S, et al.: A case of giant primary splenic hydatid cyst: Case report. Ann. Med. Surg. déc 2022 [cité 28 déc 2023]; 84. PubMed Abstract | Publisher Full Text | Free Full Text
3. Pukar MM, Pukar SM: Giant solitary hydatid cyst of spleen—A case report. Int. J. Surg. Case Rep. 2013; 4(4): 435–437. PubMed Abstract | Publisher Full Text | Free Full Text
4. Oumar TA, Ibrahima K, Sitor SI, et al.: Kyste hydatique de la rate: à propos d’un cas. Pan Afr. Med. J. 2013 [cité 28 déc 2023]; 14. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source
5. Ousadden A, Raiss M, Hrora A, et al.: Kystes hydatiques de la rate: chirurgie radicale ou conservatrice?
6. Al-Hakkak SMM, Muhammad AS, Mijbas SA-R, et al.: Splenic-preserving surgery in hydatid spleen: a single institutional experience. J. Med. Life. janv 2022; 15(1): 15–19. PubMed Abstract | Publisher Full Text | Free Full Text
7. Mejri A, Arfaoui K, Ayadi MF, et al.: Primitive isolated hydatid cyst of the spleen: total splenectomy versus spleen saving surgical modalities. BMC Surg. déc. 2021; 21(1): 46. PubMed Abstract | Publisher Full Text | Free Full Text
8. Aksakal N, Kement M, Okkabaz N, et al.: Unusually located primary hydatid cysts. Turk. J. Surg. 14 juin 2016; 32(2): 130–133. PubMed Abstract | Publisher Full Text | Free Full Text
9. Buscemi C, Randazzo C, Buscemi P, et al.: Very Prolonged Treatment with Albendazole of a Case of Disseminated Abdominal Cystic Echinococcosis. Trop. Med. Infect. Dis [Internet]. 15 sept 2023 [cité 7 janv 2025]; 8(9): 449. Reference Source

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Version 3

VERSION 3 PUBLISHED 04 Dec 2024

Author details Author details

¹ General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Sfax, Tunisia

Amina Chaka
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Wael Boujelbène
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Writing – Original Draft Preparation, Writing – Review & Editing

Amin Chaabouni
Roles: Conceptualization, Data Curation, Investigation, Resources, Writing – Original Draft Preparation

Mohamed Ali Bahloul
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Nizar Kardoun
Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Visualization

Salah Boujelben
Roles: Investigation, Methodology, Project Administration, Supervision, Validation, Visualization

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (3)

version 3

Revised

Published: 02 Jun 2025, 13:1480

https://doi.org/10.12688/f1000research.159480.3

version 2

Revised

Published: 10 Jan 2025, 13:1480

https://doi.org/10.12688/f1000research.159480.2

version 1

Published: 04 Dec 2024, 13:1480

https://doi.org/10.12688/f1000research.159480.1

© 2025 Chaka A et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Chaka A, Boujelbène W, Chaabouni A et al. Case Report: A giant ruptured splenic hydatic cyst in a patient with a complete situs inversus: Diagnostic challenge and intra-operative difficulties [version 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2025, 13:1480 (https://doi.org/10.12688/f1000research.159480.2)

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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

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Version 2

VERSION 2

PUBLISHED 10 Jan 2025

Revised

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Reviewer Report 22 Mar 2025

Ali Bilal Ulas, Ataturk University, Erzurum, Turkey

Approved with Reservations

https://doi.org/10.5256/f1000research.176728.r371891

Thanks for this manuscript that presents a case report of a giant ruptured splenic hydatid cyst in a patient with complete situs inversus, which is a rare and clinically significant condition.
The case is highly unusual due to the combination of a giant splenic hydatid cyst and complete situs inversus, making it a valuable contribution to the medical literature. The report provides a thorough account of the diagnostic process, including imaging findings, and the surgical approach, which is beneficial for practitioners facing similar challenges.
The introduction could benefit from a more focused thesis statement that explicitly outlines the key aspects of the case report such as the diagnostic challenges, surgical difficulties, and the uniqueness of the presentation.
The flow of information is sometimes disjointed. For instance, the discussion section could be better organized to present a more logical argument.
How does this case contribute to the understanding of hydatid cysts in atypical locations? What are the specific challenges posed by situs inversus in surgical interventions, and how can they be mitigated in future cases?
The manuscript suffers from numerous grammatical errors, typos, and awkward phrasing. For example:
"A 50-year-old female, without no medical history presented to the emergency department with right hypochondrium pain." (Double negative: "without no" should be "with no").
"The samples were then infected." (Unclear phrasing: It should be clarified whether the samples were found to be infected or if they became infected during the procedure).
"The cyst exhibited a detached internal membrane, a characteristic sign suggestive of a type III hydatid cyst according to the Gharbi classification." (This sentence is somewhat redundant and could be streamlined for clarity).

Is the background of the case’s history and progression described in sufficient detail?

Partly
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Yes
Is the case presented with sufficient detail to be useful for other practitioners?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Thoracic Surgery

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 09 Aug 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

09 Aug 2025

Author Response
We sincerely thank the reviewer for their careful reading and constructive feedback regarding our manuscript presenting a case of a giant ruptured splenic hydatid cyst in a patient with complete ... Continue reading
We sincerely thank the reviewer for their careful reading and constructive feedback regarding our manuscript presenting a case of a giant ruptured splenic hydatid cyst in a patient with complete situs inversus.

Regarding the introduction and thesis statement:
We appreciate the suggestion to provide a more focused thesis statement. We have revised the introduction to explicitly highlight the key aspects of the case, including the diagnostic challenges posed by the rare splenic localization and rupture, the surgical difficulties related to situs inversus, and the uniqueness of this clinical presentation. This revision aims to better guide the reader through the scope and significance of our report.

Regarding the flow and organization of the discussion:
We have reorganized the discussion section to improve logical flow, dividing it clearly into epidemiology, clinical and diagnostic considerations, therapeutic management management and our case contribution. This restructuring enhances clarity and strengthens the argumentation.

Contribution to the understanding of hydatid cysts in atypical locations and surgical challenges of situs inversus:
We have expanded the discussion to clearly address how this case contributes to medical knowledge by reporting the first documented giant splenic hydatid cyst associated with situs inversus and intra-abdominal rupture. We emphasize the rarity and clinical significance of this presentation and the necessity of maintaining suspicion for hydatid disease in atypical locations, especially in endemic areas.
Furthermore, we detailed the specific surgical challenges posed by situs inversus, including reversed anatomy, altered vascular landmarks, and the increased risk of intraoperative complications. We also outlined strategies to mitigate these risks, such as comprehensive preoperative imaging, interdisciplinary planning, and careful intraoperative navigation.

Regarding grammatical errors, typos, and phrasing:
We appreciate the reviewer’s attention to language accuracy. All identified errors, have been carefully corrected and refined to improve clarity and readability.

We hope these revisions meet the reviewer’s expectations and improve the manuscript’s overall quality. We remain open to further suggestions.
We sincerely thank the reviewer for their careful reading and constructive feedback regarding our manuscript presenting a case of a giant ruptured splenic hydatid cyst in a patient with complete situs inversus.

Regarding the introduction and thesis statement:
We appreciate the suggestion to provide a more focused thesis statement. We have revised the introduction to explicitly highlight the key aspects of the case, including the diagnostic challenges posed by the rare splenic localization and rupture, the surgical difficulties related to situs inversus, and the uniqueness of this clinical presentation. This revision aims to better guide the reader through the scope and significance of our report.

Regarding the flow and organization of the discussion:
We have reorganized the discussion section to improve logical flow, dividing it clearly into epidemiology, clinical and diagnostic considerations, therapeutic management management and our case contribution. This restructuring enhances clarity and strengthens the argumentation.

Contribution to the understanding of hydatid cysts in atypical locations and surgical challenges of situs inversus:
We have expanded the discussion to clearly address how this case contributes to medical knowledge by reporting the first documented giant splenic hydatid cyst associated with situs inversus and intra-abdominal rupture. We emphasize the rarity and clinical significance of this presentation and the necessity of maintaining suspicion for hydatid disease in atypical locations, especially in endemic areas.
Furthermore, we detailed the specific surgical challenges posed by situs inversus, including reversed anatomy, altered vascular landmarks, and the increased risk of intraoperative complications. We also outlined strategies to mitigate these risks, such as comprehensive preoperative imaging, interdisciplinary planning, and careful intraoperative navigation.

Regarding grammatical errors, typos, and phrasing:
We appreciate the reviewer’s attention to language accuracy. All identified errors, have been carefully corrected and refined to improve clarity and readability.

We hope these revisions meet the reviewer’s expectations and improve the manuscript’s overall quality. We remain open to further suggestions.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 09 Aug 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

09 Aug 2025

Author Response
We sincerely thank the reviewer for their careful reading and constructive feedback regarding our manuscript presenting a case of a giant ruptured splenic hydatid cyst in a patient with complete ... Continue reading
We sincerely thank the reviewer for their careful reading and constructive feedback regarding our manuscript presenting a case of a giant ruptured splenic hydatid cyst in a patient with complete situs inversus.

Regarding the introduction and thesis statement:
We appreciate the suggestion to provide a more focused thesis statement. We have revised the introduction to explicitly highlight the key aspects of the case, including the diagnostic challenges posed by the rare splenic localization and rupture, the surgical difficulties related to situs inversus, and the uniqueness of this clinical presentation. This revision aims to better guide the reader through the scope and significance of our report.

Regarding the flow and organization of the discussion:
We have reorganized the discussion section to improve logical flow, dividing it clearly into epidemiology, clinical and diagnostic considerations, therapeutic management management and our case contribution. This restructuring enhances clarity and strengthens the argumentation.

Contribution to the understanding of hydatid cysts in atypical locations and surgical challenges of situs inversus:
We have expanded the discussion to clearly address how this case contributes to medical knowledge by reporting the first documented giant splenic hydatid cyst associated with situs inversus and intra-abdominal rupture. We emphasize the rarity and clinical significance of this presentation and the necessity of maintaining suspicion for hydatid disease in atypical locations, especially in endemic areas.
Furthermore, we detailed the specific surgical challenges posed by situs inversus, including reversed anatomy, altered vascular landmarks, and the increased risk of intraoperative complications. We also outlined strategies to mitigate these risks, such as comprehensive preoperative imaging, interdisciplinary planning, and careful intraoperative navigation.

Regarding grammatical errors, typos, and phrasing:
We appreciate the reviewer’s attention to language accuracy. All identified errors, have been carefully corrected and refined to improve clarity and readability.

We hope these revisions meet the reviewer’s expectations and improve the manuscript’s overall quality. We remain open to further suggestions.
We sincerely thank the reviewer for their careful reading and constructive feedback regarding our manuscript presenting a case of a giant ruptured splenic hydatid cyst in a patient with complete situs inversus.

Regarding the introduction and thesis statement:
We appreciate the suggestion to provide a more focused thesis statement. We have revised the introduction to explicitly highlight the key aspects of the case, including the diagnostic challenges posed by the rare splenic localization and rupture, the surgical difficulties related to situs inversus, and the uniqueness of this clinical presentation. This revision aims to better guide the reader through the scope and significance of our report.

Regarding the flow and organization of the discussion:
We have reorganized the discussion section to improve logical flow, dividing it clearly into epidemiology, clinical and diagnostic considerations, therapeutic management management and our case contribution. This restructuring enhances clarity and strengthens the argumentation.

Contribution to the understanding of hydatid cysts in atypical locations and surgical challenges of situs inversus:
We have expanded the discussion to clearly address how this case contributes to medical knowledge by reporting the first documented giant splenic hydatid cyst associated with situs inversus and intra-abdominal rupture. We emphasize the rarity and clinical significance of this presentation and the necessity of maintaining suspicion for hydatid disease in atypical locations, especially in endemic areas.
Furthermore, we detailed the specific surgical challenges posed by situs inversus, including reversed anatomy, altered vascular landmarks, and the increased risk of intraoperative complications. We also outlined strategies to mitigate these risks, such as comprehensive preoperative imaging, interdisciplinary planning, and careful intraoperative navigation.

Regarding grammatical errors, typos, and phrasing:
We appreciate the reviewer’s attention to language accuracy. All identified errors, have been carefully corrected and refined to improve clarity and readability.

We hope these revisions meet the reviewer’s expectations and improve the manuscript’s overall quality. We remain open to further suggestions.
Competing Interests: No competing interests were disclosed. Close
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Version 1

VERSION 1

PUBLISHED 04 Dec 2024

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Reviewer Report 07 Jan 2025

Silvio Buscemi, AOU Policlinico "P. Giaccone", Policlinico University Hospital, University of Palermo, Palermo, Italy

Approved

https://doi.org/10.5256/f1000research.175212.r349374

The case described is very interesting and well-written. I have some general considerations for you below.
It is appropriate to discuss cystic echinococcosis in female with obesity.
Given the unique nature of this case with situs inversus, including descriptive arrows in the CT images is essential and reassuring. This will provide clear visual guidance for the reader, enhancing their confidence in the case report.
Please elaborate on the antiparasitic treatment used, including the specific regimen followed (it is important to continue the treatment after the cyst spontaneously ruptures to avoid possible dissemination).
It is essential to document the changes in antibody titers and blood chemistry tests following surgical treatment and therapy (it would be appropriate to document how in the article, that could also be mentioned: Ref 1). This will not only inform the reader but also enhance their knowledge about the progression of the disease.

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Partly
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Partly
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

References

1. Buscemi C, Randazzo C, Buscemi P, Caldarella R, et al.: Very Prolonged Treatment with Albendazole of a Case of Disseminated Abdominal Cystic Echinococcosis. Tropical Medicine and Infectious Disease. 2023; 8 (9). Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: internal medicine, obesity, metabolic disease

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Author Response 10 Jan 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

10 Jan 2025

Author Response

Dear Dr. Silvio Buscemi,
Thank you for your insightful comments and positive feedback regarding our case report. We appreciate your valuable suggestions, which have significantly improved the quality of our ... Continue reading Dear Dr. Silvio Buscemi,
Thank you for your insightful comments and positive feedback regarding our case report. We appreciate your valuable suggestions, which have significantly improved the quality of our work. Please find our responses to your considerations below:
1. Discussion of cystic echinococcosis in females with obesity
In the surgical treatment of abdominal cystic echinococcosis, obesity can complicate operative exposure due to increased intra-abdominal fat, making visualization and access to the surgical field more challenging. This raises the risk of spillage or injury to adjacent structures and may prolong operative time. Obesity-related comorbidities can further increase perioperative risks, highlighting the need for careful preoperative planning and surgical expertise.
2. Inclusion of descriptive arrows in CT images
We acknowledge the importance of providing clear visual guidance in the CT images. Descriptive arrows have been added to highlight key findings, especially given the unique presentation of situs inversus.
3. Details of the antiparasitic treatment regimen
We have expanded the description of the antiparasitic treatment regimen, specifying the protocol followed, including dosages, treatment duration, and intervals. This addition highlights the importance of continuing medical therapy after cyst rupture to prevent dissemination and recurrence.
4. Documentation of antibody titers and blood chemistry changes
We have included detailed data on the evolution of antibody titers and blood chemistry tests post-surgery and during therapy. These additions are presented in the results sections to provide a comprehensive view of disease progression and response to treatment.
5. References
We have incorporated your suggested reference to complement our discussion and to underline the importance of prolonged treatment with albendazole in managing disseminated cystic echinococcosis.
6.Additional improvements
We have ensured that the background, physical examination findings, diagnostic tests, and treatment outcomes are presented in greater detail. The discussion has also been expanded to highlight the importance of our findings for future understanding and management of similar cases.We hope these revisions address your comments and enhance the quality and utility of our case report for other practitioners. Thank you for your time, expertise, and valuable feedback.
Sincerely,
Dear Dr. Silvio Buscemi,
Thank you for your insightful comments and positive feedback regarding our case report. We appreciate your valuable suggestions, which have significantly improved the quality of our work. Please find our responses to your considerations below:
1. Discussion of cystic echinococcosis in females with obesity
In the surgical treatment of abdominal cystic echinococcosis, obesity can complicate operative exposure due to increased intra-abdominal fat, making visualization and access to the surgical field more challenging. This raises the risk of spillage or injury to adjacent structures and may prolong operative time. Obesity-related comorbidities can further increase perioperative risks, highlighting the need for careful preoperative planning and surgical expertise.
2. Inclusion of descriptive arrows in CT images
We acknowledge the importance of providing clear visual guidance in the CT images. Descriptive arrows have been added to highlight key findings, especially given the unique presentation of situs inversus.
3. Details of the antiparasitic treatment regimen
We have expanded the description of the antiparasitic treatment regimen, specifying the protocol followed, including dosages, treatment duration, and intervals. This addition highlights the importance of continuing medical therapy after cyst rupture to prevent dissemination and recurrence.
4. Documentation of antibody titers and blood chemistry changes
We have included detailed data on the evolution of antibody titers and blood chemistry tests post-surgery and during therapy. These additions are presented in the results sections to provide a comprehensive view of disease progression and response to treatment.
5. References
We have incorporated your suggested reference to complement our discussion and to underline the importance of prolonged treatment with albendazole in managing disseminated cystic echinococcosis.
6.Additional improvements
We have ensured that the background, physical examination findings, diagnostic tests, and treatment outcomes are presented in greater detail. The discussion has also been expanded to highlight the importance of our findings for future understanding and management of similar cases.We hope these revisions address your comments and enhance the quality and utility of our case report for other practitioners. Thank you for your time, expertise, and valuable feedback.
Sincerely,
Competing Interests: No competing interests were disclosed. Close
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Author Response 10 Jan 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

10 Jan 2025

Author Response

Dear Dr. Silvio Buscemi,
Thank you for your insightful comments and positive feedback regarding our case report. We appreciate your valuable suggestions, which have significantly improved the quality of our ... Continue reading Dear Dr. Silvio Buscemi,
Thank you for your insightful comments and positive feedback regarding our case report. We appreciate your valuable suggestions, which have significantly improved the quality of our work. Please find our responses to your considerations below:
1. Discussion of cystic echinococcosis in females with obesity
In the surgical treatment of abdominal cystic echinococcosis, obesity can complicate operative exposure due to increased intra-abdominal fat, making visualization and access to the surgical field more challenging. This raises the risk of spillage or injury to adjacent structures and may prolong operative time. Obesity-related comorbidities can further increase perioperative risks, highlighting the need for careful preoperative planning and surgical expertise.
2. Inclusion of descriptive arrows in CT images
We acknowledge the importance of providing clear visual guidance in the CT images. Descriptive arrows have been added to highlight key findings, especially given the unique presentation of situs inversus.
3. Details of the antiparasitic treatment regimen
We have expanded the description of the antiparasitic treatment regimen, specifying the protocol followed, including dosages, treatment duration, and intervals. This addition highlights the importance of continuing medical therapy after cyst rupture to prevent dissemination and recurrence.
4. Documentation of antibody titers and blood chemistry changes
We have included detailed data on the evolution of antibody titers and blood chemistry tests post-surgery and during therapy. These additions are presented in the results sections to provide a comprehensive view of disease progression and response to treatment.
5. References
We have incorporated your suggested reference to complement our discussion and to underline the importance of prolonged treatment with albendazole in managing disseminated cystic echinococcosis.
6.Additional improvements
We have ensured that the background, physical examination findings, diagnostic tests, and treatment outcomes are presented in greater detail. The discussion has also been expanded to highlight the importance of our findings for future understanding and management of similar cases.We hope these revisions address your comments and enhance the quality and utility of our case report for other practitioners. Thank you for your time, expertise, and valuable feedback.
Sincerely,
Dear Dr. Silvio Buscemi,
Thank you for your insightful comments and positive feedback regarding our case report. We appreciate your valuable suggestions, which have significantly improved the quality of our work. Please find our responses to your considerations below:
1. Discussion of cystic echinococcosis in females with obesity
In the surgical treatment of abdominal cystic echinococcosis, obesity can complicate operative exposure due to increased intra-abdominal fat, making visualization and access to the surgical field more challenging. This raises the risk of spillage or injury to adjacent structures and may prolong operative time. Obesity-related comorbidities can further increase perioperative risks, highlighting the need for careful preoperative planning and surgical expertise.
2. Inclusion of descriptive arrows in CT images
We acknowledge the importance of providing clear visual guidance in the CT images. Descriptive arrows have been added to highlight key findings, especially given the unique presentation of situs inversus.
3. Details of the antiparasitic treatment regimen
We have expanded the description of the antiparasitic treatment regimen, specifying the protocol followed, including dosages, treatment duration, and intervals. This addition highlights the importance of continuing medical therapy after cyst rupture to prevent dissemination and recurrence.
4. Documentation of antibody titers and blood chemistry changes
We have included detailed data on the evolution of antibody titers and blood chemistry tests post-surgery and during therapy. These additions are presented in the results sections to provide a comprehensive view of disease progression and response to treatment.
5. References
We have incorporated your suggested reference to complement our discussion and to underline the importance of prolonged treatment with albendazole in managing disseminated cystic echinococcosis.
6.Additional improvements
We have ensured that the background, physical examination findings, diagnostic tests, and treatment outcomes are presented in greater detail. The discussion has also been expanded to highlight the importance of our findings for future understanding and management of similar cases.We hope these revisions address your comments and enhance the quality and utility of our case report for other practitioners. Thank you for your time, expertise, and valuable feedback.
Sincerely,
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 28 Dec 2024

Selmy Awad, Mansoura University Hospitals, El-Gomhouria Street, El-Mansoura, Egypt

Approved with Reservations

https://doi.org/10.5256/f1000research.175212.r349375

Thanks for the novel case as an incidence and location.
many typos and grammar mistakes are abundant.
... Continue reading

Thanks for the novel case as an incidence and location.
many typos and grammar mistakes are abundant.
What is the role of medical treatment in preoperative preparation and post-operative regimens?
please follow the standards for writing case reports

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

No
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: acute care ,trauma ,laparoscopy

CITE

Report a concern

Author Response 10 Jan 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

10 Jan 2025

Author Response

Dear Dr. Selmy Awad:
Thank you for your valuable feedback on the case report. I appreciate your thoughtful insights and constructive criticism.
1. Typos and Grammar Mistakes: We acknowledge that ... Continue reading Dear Dr. Selmy Awad:
Thank you for your valuable feedback on the case report. I appreciate your thoughtful insights and constructive criticism.
1. Typos and Grammar Mistakes: We acknowledge that there were some typos and grammatical errors in the manuscript. These will be carefully reviewed and corrected to ensure clarity and professionalism in the final version.
2. Role of Medical Treatment in Preoperative and Postoperative Regimens: You have raised an important point regarding the role of medical treatment in both preoperative preparation and postoperative regimens. We will include a more comprehensive discussion on the medical management, emphasizing its significance in patient preparation before surgery, as well as in the postoperative care to enhance recovery and prevent complications.
3. Standards for Writing Case Reports: We will ensure that the case report is fully aligned with the standards for writing case reports. This will involve revising the structure and adding any missing sections to enhance the clarity and scientific rigor.
4. Importance of Findings and Relevance to Disease Understanding: We appreciate your observation about the lack of a detailed discussion regarding the importance of the findings and their relevance to future disease understanding. We will expand this section to explain the significance of the case in relation to broader disease processes, diagnosis, and treatment. This will help contextualize the findings for future research and clinical practice.
5. Sufficiency of Details for Other Practitioners: We will review the report to ensure that enough practical insights and relevant details are provided for it to be a useful reference for others in the field.
Thank you again for your review. We will address these concerns thoroughly in the revised version of the manuscript.
Dear Dr. Selmy Awad:
Thank you for your valuable feedback on the case report. I appreciate your thoughtful insights and constructive criticism.
1. Typos and Grammar Mistakes: We acknowledge that there were some typos and grammatical errors in the manuscript. These will be carefully reviewed and corrected to ensure clarity and professionalism in the final version.
2. Role of Medical Treatment in Preoperative and Postoperative Regimens: You have raised an important point regarding the role of medical treatment in both preoperative preparation and postoperative regimens. We will include a more comprehensive discussion on the medical management, emphasizing its significance in patient preparation before surgery, as well as in the postoperative care to enhance recovery and prevent complications.
3. Standards for Writing Case Reports: We will ensure that the case report is fully aligned with the standards for writing case reports. This will involve revising the structure and adding any missing sections to enhance the clarity and scientific rigor.
4. Importance of Findings and Relevance to Disease Understanding: We appreciate your observation about the lack of a detailed discussion regarding the importance of the findings and their relevance to future disease understanding. We will expand this section to explain the significance of the case in relation to broader disease processes, diagnosis, and treatment. This will help contextualize the findings for future research and clinical practice.
5. Sufficiency of Details for Other Practitioners: We will review the report to ensure that enough practical insights and relevant details are provided for it to be a useful reference for others in the field.
Thank you again for your review. We will address these concerns thoroughly in the revised version of the manuscript.
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 10 Jan 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

10 Jan 2025

Author Response

Dear Dr. Selmy Awad:
Thank you for your valuable feedback on the case report. I appreciate your thoughtful insights and constructive criticism.
1. Typos and Grammar Mistakes: We acknowledge that ... Continue reading Dear Dr. Selmy Awad:
Thank you for your valuable feedback on the case report. I appreciate your thoughtful insights and constructive criticism.
1. Typos and Grammar Mistakes: We acknowledge that there were some typos and grammatical errors in the manuscript. These will be carefully reviewed and corrected to ensure clarity and professionalism in the final version.
2. Role of Medical Treatment in Preoperative and Postoperative Regimens: You have raised an important point regarding the role of medical treatment in both preoperative preparation and postoperative regimens. We will include a more comprehensive discussion on the medical management, emphasizing its significance in patient preparation before surgery, as well as in the postoperative care to enhance recovery and prevent complications.
3. Standards for Writing Case Reports: We will ensure that the case report is fully aligned with the standards for writing case reports. This will involve revising the structure and adding any missing sections to enhance the clarity and scientific rigor.
4. Importance of Findings and Relevance to Disease Understanding: We appreciate your observation about the lack of a detailed discussion regarding the importance of the findings and their relevance to future disease understanding. We will expand this section to explain the significance of the case in relation to broader disease processes, diagnosis, and treatment. This will help contextualize the findings for future research and clinical practice.
5. Sufficiency of Details for Other Practitioners: We will review the report to ensure that enough practical insights and relevant details are provided for it to be a useful reference for others in the field.
Thank you again for your review. We will address these concerns thoroughly in the revised version of the manuscript.
Dear Dr. Selmy Awad:
Thank you for your valuable feedback on the case report. I appreciate your thoughtful insights and constructive criticism.
1. Typos and Grammar Mistakes: We acknowledge that there were some typos and grammatical errors in the manuscript. These will be carefully reviewed and corrected to ensure clarity and professionalism in the final version.
2. Role of Medical Treatment in Preoperative and Postoperative Regimens: You have raised an important point regarding the role of medical treatment in both preoperative preparation and postoperative regimens. We will include a more comprehensive discussion on the medical management, emphasizing its significance in patient preparation before surgery, as well as in the postoperative care to enhance recovery and prevent complications.
3. Standards for Writing Case Reports: We will ensure that the case report is fully aligned with the standards for writing case reports. This will involve revising the structure and adding any missing sections to enhance the clarity and scientific rigor.
4. Importance of Findings and Relevance to Disease Understanding: We appreciate your observation about the lack of a detailed discussion regarding the importance of the findings and their relevance to future disease understanding. We will expand this section to explain the significance of the case in relation to broader disease processes, diagnosis, and treatment. This will help contextualize the findings for future research and clinical practice.
5. Sufficiency of Details for Other Practitioners: We will review the report to ensure that enough practical insights and relevant details are provided for it to be a useful reference for others in the field.
Thank you again for your review. We will address these concerns thoroughly in the revised version of the manuscript.
Competing Interests: No competing interests were disclosed. Close
Report a concern

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Version 3

VERSION 3 PUBLISHED 04 Dec 2024

Open Peer Review

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	1	2	3
Version 3 (revision) 02 Jun 25			read
Version 2 (revision) 10 Jan 25			read
Version 1 04 Dec 24	read	read

Selmy Awad, Mansoura University Hospitals, El-Gomhouria Street, El-Mansoura, Egypt
Silvio Buscemi, University of Palermo, Palermo, Italy
Ali Bilal Ulas, Ataturk University, Erzurum, Turkey

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Reviewer Report

3 Views

06 Jun 2025 | for Version 3

Ali Bilal Ulas, Ataturk University, Erzurum, Turkey

3 Views Cite this report Responses(0)

Approved

Dear Editor and Authors,
I thank you for addressing my suggestions thoroughly in the revised version of the manuscript. The updated text shows clear improvements in structure, clarity, and scientific rigor. The discussion is now better organized, the language has been polished, and the significance of the case particularly in relation to hydatid cysts in atypical locations and surgical management in situs inversus is well articulated.
Best regards,

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Thoracic Surgery

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

29 Views

22 Mar 2025 | for Version 2

Ali Bilal Ulas, Ataturk University, Erzurum, Turkey

29 Views Cite this report Responses(1)

Approved With Reservations

Is the background of the case’s history and progression described in sufficient detail?

Partly
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Yes
Is the case presented with sufficient detail to be useful for other practitioners?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Thoracic Surgery

Respond to this report

Responses (1)

Author Response

09 Aug 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

We sincerely thank the reviewer for their careful reading and constructive feedback regarding our manuscript presenting a case of a giant ruptured splenic hydatid cyst in a patient with complete situs inversus.

Regarding the introduction and thesis statement:
We appreciate the suggestion to provide a more focused thesis statement. We have revised the introduction to explicitly highlight the key aspects of the case, including the diagnostic challenges posed by the rare splenic localization and rupture, the surgical difficulties related to situs inversus, and the uniqueness of this clinical presentation. This revision aims to better guide the reader through the scope and significance of our report.
Regarding the flow and organization of the discussion:
We have reorganized the discussion section to improve logical flow, dividing it clearly into epidemiology, clinical and diagnostic considerations, therapeutic management management and our case contribution. This restructuring enhances clarity and strengthens the argumentation.
Contribution to the understanding of hydatid cysts in atypical locations and surgical challenges of situs inversus:
We have expanded the discussion to clearly address how this case contributes to medical knowledge by reporting the first documented giant splenic hydatid cyst associated with situs inversus and intra-abdominal rupture. We emphasize the rarity and clinical significance of this presentation and the necessity of maintaining suspicion for hydatid disease in atypical locations, especially in endemic areas.
Furthermore, we detailed the specific surgical challenges posed by situs inversus, including reversed anatomy, altered vascular landmarks, and the increased risk of intraoperative complications. We also outlined strategies to mitigate these risks, such as comprehensive preoperative imaging, interdisciplinary planning, and careful intraoperative navigation.
Regarding grammatical errors, typos, and phrasing:
We appreciate the reviewer’s attention to language accuracy. All identified errors, have been carefully corrected and refined to improve clarity and readability.

We hope these revisions meet the reviewer’s expectations and improve the manuscript’s overall quality. We remain open to further suggestions.

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

13 Views

07 Jan 2025 | for Version 1

Silvio Buscemi, AOU Policlinico "P. Giaccone", Policlinico University Hospital, University of Palermo, Palermo, Italy

13 Views Cite this report Responses(1)

Approved

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Partly
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Partly
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

References

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

internal medicine, obesity, metabolic disease

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (1)

Author Response

10 Jan 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

Dear Dr. Silvio Buscemi,
Thank you for your insightful comments and positive feedback regarding our case report. We appreciate your valuable suggestions, which have significantly improved the quality of our work. Please find our responses to your considerations below:
1. Discussion of cystic echinococcosis in females with obesity
In the surgical treatment of abdominal cystic echinococcosis, obesity can complicate operative exposure due to increased intra-abdominal fat, making visualization and access to the surgical field more challenging. This raises the risk of spillage or injury to adjacent structures and may prolong operative time. Obesity-related comorbidities can further increase perioperative risks, highlighting the need for careful preoperative planning and surgical expertise.
2. Inclusion of descriptive arrows in CT images
We acknowledge the importance of providing clear visual guidance in the CT images. Descriptive arrows have been added to highlight key findings, especially given the unique presentation of situs inversus.
3. Details of the antiparasitic treatment regimen
We have expanded the description of the antiparasitic treatment regimen, specifying the protocol followed, including dosages, treatment duration, and intervals. This addition highlights the importance of continuing medical therapy after cyst rupture to prevent dissemination and recurrence.
4. Documentation of antibody titers and blood chemistry changes
We have included detailed data on the evolution of antibody titers and blood chemistry tests post-surgery and during therapy. These additions are presented in the results sections to provide a comprehensive view of disease progression and response to treatment.
5. References
We have incorporated your suggested reference to complement our discussion and to underline the importance of prolonged treatment with albendazole in managing disseminated cystic echinococcosis.
6.Additional improvements
We have ensured that the background, physical examination findings, diagnostic tests, and treatment outcomes are presented in greater detail. The discussion has also been expanded to highlight the importance of our findings for future understanding and management of similar cases.We hope these revisions address your comments and enhance the quality and utility of our case report for other practitioners. Thank you for your time, expertise, and valuable feedback.
Sincerely,

View more View less

Competing Interests

No competing interests were disclosed.

Back to all reports

Reviewer Report

18 Views

28 Dec 2024 | for Version 1

Selmy Awad, Mansoura University Hospitals, El-Gomhouria Street, El-Mansoura, Egypt

18 Views Cite this report Responses(1)

Approved With Reservations

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

No
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

acute care ,trauma ,laparoscopy

Respond to this report

Responses (1)

Author Response

10 Jan 2025

Wael Boujelbène, General Surgery, Department-Habib Bourguiba Hospital, Universite de Sfax Faculte de Medecine de Sfax, Sfax, Tunisia

Dear Dr. Selmy Awad:
Thank you for your valuable feedback on the case report. I appreciate your thoughtful insights and constructive criticism.
1. Typos and Grammar Mistakes: We acknowledge that there were some typos and grammatical errors in the manuscript. These will be carefully reviewed and corrected to ensure clarity and professionalism in the final version.
2. Role of Medical Treatment in Preoperative and Postoperative Regimens: You have raised an important point regarding the role of medical treatment in both preoperative preparation and postoperative regimens. We will include a more comprehensive discussion on the medical management, emphasizing its significance in patient preparation before surgery, as well as in the postoperative care to enhance recovery and prevent complications.
3. Standards for Writing Case Reports: We will ensure that the case report is fully aligned with the standards for writing case reports. This will involve revising the structure and adding any missing sections to enhance the clarity and scientific rigor.
4. Importance of Findings and Relevance to Disease Understanding: We appreciate your observation about the lack of a detailed discussion regarding the importance of the findings and their relevance to future disease understanding. We will expand this section to explain the significance of the case in relation to broader disease processes, diagnosis, and treatment. This will help contextualize the findings for future research and clinical practice.
5. Sufficiency of Details for Other Practitioners: We will review the report to ensure that enough practical insights and relevant details are provided for it to be a useful reference for others in the field.
Thank you again for your review. We will address these concerns thoroughly in the revised version of the manuscript.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Hassan A, Azhar A, Mazhar S, et al.: A rare case of recurrent hydatid cyst of the spleen: A case report. Radiol. Case Rep. oct 2023; 18(10): 3406–3409. PubMed Abstract | Publisher Full Text | Free Full Text

[2] 2. Singh S, Kisee S, Amatya S, et al.: A case of giant primary splenic hydatid cyst: Case report. Ann. Med. Surg. déc 2022 [cité 28 déc 2023]; 84. PubMed Abstract | Publisher Full Text | Free Full Text

[3] 3. Pukar MM, Pukar SM: Giant solitary hydatid cyst of spleen—A case report. Int. J. Surg. Case Rep. 2013; 4(4): 435–437. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. Oumar TA, Ibrahima K, Sitor SI, et al.: Kyste hydatique de la rate: à propos d’un cas. Pan Afr. Med. J. 2013 [cité 28 déc 2023]; 14. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source

[5] 5. Ousadden A, Raiss M, Hrora A, et al.: Kystes hydatiques de la rate: chirurgie radicale ou conservatrice?

[6] 6. Al-Hakkak SMM, Muhammad AS, Mijbas SA-R, et al.: Splenic-preserving surgery in hydatid spleen: a single institutional experience. J. Med. Life. janv 2022; 15(1): 15–19. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Mejri A, Arfaoui K, Ayadi MF, et al.: Primitive isolated hydatid cyst of the spleen: total splenectomy versus spleen saving surgical modalities. BMC Surg. déc. 2021; 21(1): 46. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Aksakal N, Kement M, Okkabaz N, et al.: Unusually located primary hydatid cysts. Turk. J. Surg. 14 juin 2016; 32(2): 130–133. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Buscemi C, Randazzo C, Buscemi P, et al.: Very Prolonged Treatment with Albendazole of a Case of Disseminated Abdominal Cystic Echinococcosis. Trop. Med. Infect. Dis [Internet]. 15 sept 2023 [cité 7 janv 2025]; 8(9): 449. Reference Source

Case Report: A giant ruptured splenic hydatic cyst in a patient with a complete situs inversus: Diagnostic challenge and intra-operative difficulties

Abstract

Keywords

Revised Amendments from Version 1

Introduction

Observation

Patient information

Clinical findings

Diagnostic assessment

Figure 1. Splenic hydatid cyst cracking in a complete situs inversus 1.

Figure 2. Splenic hydatid cyst cracking in a complete situs inversus 2.

Therapeutic intervention

Figure 3. The splenectomy specimen and the proligere membrane of the hydatic cyst.

Follow up and outcomes

Discussion

Conclusion

Patient perspective

Informed consent statement

Data availability statement

References

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