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.

[Better adaptation of the Tunisian adolescent health care system]

Classical health indicators are insufficient to account for adolescent health. With the majority of young people's health problems being linked to social and behavioural factors, the compartmentalised and biomedical approaches to their health are inept. Can the totality of adolescents' health needs receive an appropriate response in a health care system which articulates itself based upon a parceled vision of health? Health professionals seem to experience difficulties in situating themselves above the expressed symptom, and therefore become aware of the real needs linked to the emotional, familial and educational contexts and integrate a global, multi-disciplinary approach to adolescent and young adult health into their everyday practice. Their reduced consumption of care is not only linked to the fact that adolescents in general enjoy good health, but it is also linked to the difficulties of the health care system to recognise their true health needs. It thus emphasises the need to develop competencies in the field of adolescent health and organise the work in a multi-disciplinary network. In order to accomplish this, it is essential that the medical schools and public health schools offer a multi-disciplinary approach to adolescent health allowing for future health professionals to be able to address fields which are not uniquely bio-medically dependent. Furthermore, the regional medical study and university centres must evolve to become welcome centers and care centers for adolescents, adopting a multi-disciplinary approach going beyond the simple juxtaposition of diverse disciplines.