Management of a primary retroperitoneal hydatid cyst ruptured in the abdominal wall: A case report

Primary giant hydatid cyst of the retroperitoneum: Diagnosis and therapeutic approaches

INTRODUCTION AND IMPORTANCE

Primary hydatid cyst of the retroperitoneum is an exceedingly rare manifestation of hydatid disease. Diagnosis proves challenging due to nonspecific symptoms, and the condition is typically not suspected when facing a retroperitoneal cystic mass, necessitating awareness among clinicians and surgeons, particularly in endemic regions.

CASE PRESENTATION

A 45-year-old male with a three-month history of progressive abdominal enlargement and pain. Living in a rural area, he exhibited a 30 cm, well-defined retroperitoneal cyst, with no guarding confirmed by CT-scan, with characteristic daughter cysts. The diagnosis of primary retroperitoneal hydatid cyst was supported by positive hydatid serology and eosinophilia. Surgical intervention was crucial, and a complete pericystectomy, with 4 cm of pericyst on the aorta due to safety concerns, was performed after three months of preoperative albendazole-based treatment. The postoperative course was uneventful, and a two-year follow-up revealed no recurrence.

CLINICAL DISCUSSION

The prevalence of hydatid disease in North Africa is high, yet retroperitoneal cases are rare. The difficulty to diagnosis retroperitoneal masses, underscores the importance of precise patient evaluation and detailed imaging analysis. Percutaneous puncture is contraindicated due to the risk of dissemination, highlighting even more the significance of accurate preoperative diagnosis. Surgery, coupled with Albendazole treatment, remains the gold-standard, associated with meticulous intraoperative precautions to prevent disease dissemination.

CONCLUSION

Primary retroperitoneal hydatid cyst is rare. Diagnosis is difficult. Precise determination of patient's background and detailed analysis of imaging findings are mandatory. Percutaneous puncture is forbidden as it leads to disease spreading or even anaphylactic shock. Surgical excision is the gold-standard.

Retroperitoneal hydatid cyst challenging the diagnosis: Case report with review of literature

INTRODUCTION

Hydatid cyst is a zoonotic disease caused by a tapeworm, Echinococcus granulosus. A retroperitoneal hydatid cyst is extremely rare and its diagnosis can be challenging, particularly in the early stage as it can mimic several regional pathologies like pancreatic pseudocyst, pancreatic neoplasm, and other retroperitoneal cystic lesions.

PRESENTATION OF CASE

We report a rare case of 39-year-old Nepalese male with a left retroperitoneal hydatid cyst who presented with pain and feeling of mass in the left flank region for 6 months. Diagnosis was made by abdominal computed tomography and magnetic resonance imaging and management was done by partial cystectomy.

DISCUSSION

Retroperitoneal hydatid cysts can present with chronic pain, mass, and symptoms resulting from the mass effect which varies according to the different retroperitoneal locations. Diagnosis of the retroperitoneal cyst can be challenging clinically and radiologically in its early stages. Even in the late stage, ultrasonography may not suffice and additional imaging techniques such as computed tomography or magnetic resonance imaging are required for the diagnosis.

CONCLUSION

In endemic areas, hydatid cyst should be considered while dealing with a retroperitoneal swelling for early diagnosis and prevention of rupture. With a high level of clinical suspicion and radiological findings, retroperitoneal hydatid cyst can be diagnosed and surgery is the principal method of treatment.

An uncommon way of revelation of a primary diaphragmatic hydatid cyst: A case report

INTRODUCTION AND IMPORTANCE

Diaphragmatic hydatid cyst is a misdiagnosed condition. The challenge is to suspect this rare entity on nonspecific clinical features and to localize the cyst on imaging in order to determine the surgical approach. Surgery is the only curative treatment and confirmation is set on pathology examination.

CASE PRESENTATION

We present the case of a twenty-six-year-old patient, with no medical history, who complained of recurrent right thoracic pains rebel to opioids. All radiological items lead to suspect a diaphragmatic hydatid cyst. Surgery permitted a complete resection of the cyst and a total relief of the pains.

CLINICAL DISCUSSION

The diagnosis of diaphragmatic hydatid cyst is a real challenge. Several diagnoses can be evoked such as hydatid disease depending from the liver, cystic lymphangioma or neural intercostal benign tumor. The phrenic origin of the cyst can only be identified through surgery. However, it is very important to clearly characterize the lesion to well conduct surgical approach.

CONCLUSION

It is important for surgeons to suspect diaphragmatic hydatid cysts despite its rarity. CT-scan and MRI are helpful tools to localize the disease and to conduct the surgical procedure. Final diagnosis is only set on pathology examination after curative surgery.