CASE REPORT
Primary hydatid cyst of peritoneum presented as abdominal lump: a rare presentation Jayashri S. Pandya, Manoj R. Bhambare, Sudatta B. Waghmare & Ajit R. Patel Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, India
Correspondence Jayashri S. Pandya, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, India. Tel: +02223027148; Fax: 022-28548499; E-mail: [email protected] Funding Information No sources of funding were declared for this study.
Key Clinical Message The incidence of primary hydatid cyst of peritoneum is 2%. It can present as a palpable abdominal lump. The differential diagnosis is cystic ovarian tumor clinically and radiologically. Peritoneal hydatid disease should be included in differential diagnosis of sonographically diagnosed pelvic cystic lesion. Keywords Abdominal lump, extrahepatic hydatid disease, primary peritoneal hydatidosis.
Received: 21 October 2014; Accepted: 4 December 2014 Clinical Case Reports 2015; 3(5): 331–332 doi: 10.1002/ccr3.214
Introduction Primary peritoneal hydatidosis is a rare condition, even in areas where hydatid disease is endemic. Although liver and lung are the organs most commonly involved, peritoneal echinococcosis, either primary or secondary, represents an uncommon but significant manifestation of the disease. We report a case of extrahepatic primary peritoneal hydatid in a patient, who presented with a lump in the lower abdomen. Surgical excision and postoperative treatment with albendazole were effective in controlling the disease and preventing a recurrence.
in lower abdomen. Radiography of chest was normal. Initial differential diagnosis of (1) Hydatid cyst of peritoneum, (2) Ovarian cyst was made based on findings of USG and CT abdomen –pelvis. Markers of ovarian tumor were negative. On Exploratory laparotomy, there was a large cyst (50 9 25 cm) arising from pelvic peritoneum (Fig. 3A and B). There were no similar cystic masses in any other abdominal viscera. Excision of the cyst was done without any spillage. Histopathological examination showed cyst wall with a laminated membrane and inner germinal layer containing
Case Report A 45-year-old female presented with lump in lower abdomen gradually increasing in size since last 6 months, associated with dull aching pain. There were no complaints of nausea, vomiting or any bowel and bladder habits. Routine hematological and biochemical parameters were normal. Ultrasonography of abdomen revealed a large hypoechoic mass with echogenic septations in the lower abdomen (Fig. 1). Contrast-enhanced computed tomography (CECT) of abdomen and pelvis revealed a huge cyst, 30 9 25 cm in size (Fig. 2)
Figure 1. Ultrasonography findings.
ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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J. S. Pandya et al.
Primary Peritoneal Hydatid Cyst
Figure 2. Contrast-enhanced computed tomography of abdomen and pelvis findings.
(A)
(B)
Primary peritoneal hydatidosis is rare and has been reported to occur in 2% of all abdominal hydatids [2]. Intraperitoneal hydatid cysts are usually secondary to the rupture (spontaneous or accidental at surgery) of a primary hepatic, splenic, or mesenteric cyst [1]. A solitary cyst in the pelvic cavity is considered as primary when no other cysts are present. In such a case, the hydatid embryo gains access to the pelvis by hematogenous or lymphatic route [3]. Pelvic hydatid cysts usually present as a nonspecific mass with pressure effects on adjacent organs such as the rectum and urinary bladder. Rarely, they can cause obstructed labor, obstructive uropathy, and renal failure. Sometimes, they can rupture spontaneously [3]. Serology and imaging are the main tools for establishing diagnosis. Ultrasound is the preferred first-line imaging but CECT gives more precise information regarding the morphology (size, location, state of surrounding structures, and number) of the cyst. Drug treatment with albendazole has been found to be successful in a proportion of cases, but drug therapy is generally not used as the primary treatment except in cases where the patient is not fit for surgery or the cyst size is smaller or deeply located. Surgery is the most effective treatment. Combination of preoperative albendazole therapy, surgery and postoperative albendazole therapy is a useful regime. Albendazole suppresses the development of hydatid cysts following intraperitoneal inoculation of protoscolices.
Clinical Message
Figure 3. (A) Specimen of hydatid cyst. (B) Opened hydatid cyst specimen.
degenerated eosinophilic protoplasmic mass suggestive of hydatid cyst. Postoperative period was uneventful. Patient was asymptomatic at 6-month follow up.
Discussion Hydatid disease is a parasitic disease caused by infection with larva of the cestode Echinococcus granulosus. Echinococcus granulosus life cycle passes through two hosts. Humans are accidental intermediate hosts. The most common site involved is the liver (59–75%), followed by lung (27%), kidney (3%), bone (1–4%), and brain (1–2%). Other sites such as the heart, spleen, pancreas, omentum, ovaries, parametrium, pelvis, thyroid, orbit, retroperitoneum, and muscles are very rarely affected [1].
332
The incidence of primary hydatid cyst of peritoneum is 2%. It can present as a palpable abdominal lump. Clinically and radiologically, one has to differentiate it from cystic ovarian tumor. It is worth keeping peritoneal hydatid disease as a differential in ultrasonographically diagnosed pelvic cystic lesions.
Conflict of Interest None declared. References 1. Yuksel, M., G. Demirpolat, A. Sever, S. Bakaris, E. Bulbuloglu, and N. Elmas. 2007. Hydatid disease involving some rare locations in the body: a pictorial essay. Korean J. Radiol. 8:531–540. 2. Pedrosa, I., A. Saiz, J. Arrazola, J. Ferreiros, and C. S. Pedrosa. 2000. Hydatid disease: radiologic and pathologic features and complications. Radiographics 3:795–817. 3. Seenu, V., M. C. Misra, S. Tiwari, R. Jain, C. Chandrashekhar 1994. Primary pelvic hydatid cyst presenting with Obstructive uropathy and renal failure. Postgrad. Med. J. 70, 930–932.
ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Primary hydatid cyst of peritoneum presented as abdominal lump: a rare presentation Jayashri S. Pandya, Manoj R. Bhambare, Sudatta B. Waghmare & Ajit R. Patel Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, India
Correspondence Jayashri S. Pandya, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, India. Tel: +02223027148; Fax: 022-28548499; E-mail: [email protected] Funding Information No sources of funding were declared for this study.
Key Clinical Message The incidence of primary hydatid cyst of peritoneum is 2%. It can present as a palpable abdominal lump. The differential diagnosis is cystic ovarian tumor clinically and radiologically. Peritoneal hydatid disease should be included in differential diagnosis of sonographically diagnosed pelvic cystic lesion. Keywords Abdominal lump, extrahepatic hydatid disease, primary peritoneal hydatidosis.
Received: 21 October 2014; Accepted: 4 December 2014 Clinical Case Reports 2015; 3(5): 331–332 doi: 10.1002/ccr3.214
Introduction Primary peritoneal hydatidosis is a rare condition, even in areas where hydatid disease is endemic. Although liver and lung are the organs most commonly involved, peritoneal echinococcosis, either primary or secondary, represents an uncommon but significant manifestation of the disease. We report a case of extrahepatic primary peritoneal hydatid in a patient, who presented with a lump in the lower abdomen. Surgical excision and postoperative treatment with albendazole were effective in controlling the disease and preventing a recurrence.
in lower abdomen. Radiography of chest was normal. Initial differential diagnosis of (1) Hydatid cyst of peritoneum, (2) Ovarian cyst was made based on findings of USG and CT abdomen –pelvis. Markers of ovarian tumor were negative. On Exploratory laparotomy, there was a large cyst (50 9 25 cm) arising from pelvic peritoneum (Fig. 3A and B). There were no similar cystic masses in any other abdominal viscera. Excision of the cyst was done without any spillage. Histopathological examination showed cyst wall with a laminated membrane and inner germinal layer containing
Case Report A 45-year-old female presented with lump in lower abdomen gradually increasing in size since last 6 months, associated with dull aching pain. There were no complaints of nausea, vomiting or any bowel and bladder habits. Routine hematological and biochemical parameters were normal. Ultrasonography of abdomen revealed a large hypoechoic mass with echogenic septations in the lower abdomen (Fig. 1). Contrast-enhanced computed tomography (CECT) of abdomen and pelvis revealed a huge cyst, 30 9 25 cm in size (Fig. 2)
Figure 1. Ultrasonography findings.
ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
331
J. S. Pandya et al.
Primary Peritoneal Hydatid Cyst
Figure 2. Contrast-enhanced computed tomography of abdomen and pelvis findings.
(A)
(B)
Primary peritoneal hydatidosis is rare and has been reported to occur in 2% of all abdominal hydatids [2]. Intraperitoneal hydatid cysts are usually secondary to the rupture (spontaneous or accidental at surgery) of a primary hepatic, splenic, or mesenteric cyst [1]. A solitary cyst in the pelvic cavity is considered as primary when no other cysts are present. In such a case, the hydatid embryo gains access to the pelvis by hematogenous or lymphatic route [3]. Pelvic hydatid cysts usually present as a nonspecific mass with pressure effects on adjacent organs such as the rectum and urinary bladder. Rarely, they can cause obstructed labor, obstructive uropathy, and renal failure. Sometimes, they can rupture spontaneously [3]. Serology and imaging are the main tools for establishing diagnosis. Ultrasound is the preferred first-line imaging but CECT gives more precise information regarding the morphology (size, location, state of surrounding structures, and number) of the cyst. Drug treatment with albendazole has been found to be successful in a proportion of cases, but drug therapy is generally not used as the primary treatment except in cases where the patient is not fit for surgery or the cyst size is smaller or deeply located. Surgery is the most effective treatment. Combination of preoperative albendazole therapy, surgery and postoperative albendazole therapy is a useful regime. Albendazole suppresses the development of hydatid cysts following intraperitoneal inoculation of protoscolices.
Clinical Message
Figure 3. (A) Specimen of hydatid cyst. (B) Opened hydatid cyst specimen.
degenerated eosinophilic protoplasmic mass suggestive of hydatid cyst. Postoperative period was uneventful. Patient was asymptomatic at 6-month follow up.
Discussion Hydatid disease is a parasitic disease caused by infection with larva of the cestode Echinococcus granulosus. Echinococcus granulosus life cycle passes through two hosts. Humans are accidental intermediate hosts. The most common site involved is the liver (59–75%), followed by lung (27%), kidney (3%), bone (1–4%), and brain (1–2%). Other sites such as the heart, spleen, pancreas, omentum, ovaries, parametrium, pelvis, thyroid, orbit, retroperitoneum, and muscles are very rarely affected [1].
332
The incidence of primary hydatid cyst of peritoneum is 2%. It can present as a palpable abdominal lump. Clinically and radiologically, one has to differentiate it from cystic ovarian tumor. It is worth keeping peritoneal hydatid disease as a differential in ultrasonographically diagnosed pelvic cystic lesions.
Conflict of Interest None declared. References 1. Yuksel, M., G. Demirpolat, A. Sever, S. Bakaris, E. Bulbuloglu, and N. Elmas. 2007. Hydatid disease involving some rare locations in the body: a pictorial essay. Korean J. Radiol. 8:531–540. 2. Pedrosa, I., A. Saiz, J. Arrazola, J. Ferreiros, and C. S. Pedrosa. 2000. Hydatid disease: radiologic and pathologic features and complications. Radiographics 3:795–817. 3. Seenu, V., M. C. Misra, S. Tiwari, R. Jain, C. Chandrashekhar 1994. Primary pelvic hydatid cyst presenting with Obstructive uropathy and renal failure. Postgrad. Med. J. 70, 930–932.
ª 2015 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
